Provider Demographics
NPI:1639134869
Name:PNEUMEXICO RESPIRATORY, LLC
Entity Type:Organization
Organization Name:PNEUMEXICO RESPIRATORY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / RESPIRATORY THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:IAN
Authorized Official - Last Name:TRUJILLO
Authorized Official - Suffix:
Authorized Official - Credentials:CRT, RCP
Authorized Official - Phone:505-898-8808
Mailing Address - Street 1:102 MOUNTAIN PARK PL NW
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-2290
Mailing Address - Country:US
Mailing Address - Phone:505-898-8808
Mailing Address - Fax:505-898-3479
Practice Address - Street 1:102 MOUNTAIN PARK PL NW
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-2290
Practice Address - Country:US
Practice Address - Phone:505-898-8808
Practice Address - Fax:505-898-3479
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0052168332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00TA32OtherBLUE CROSS / BLUE SHEILD
NM09887253Medicaid
NM1025700OtherACM / UNITED HEALTHCARE
NM1025700OtherACM / UNITED HEALTHCARE