Provider Demographics
NPI:1669506994
Name:ACCENT ON HEALTH MEDICAL ASSOCIATES, INC.
Entity Type:Organization
Organization Name:ACCENT ON HEALTH MEDICAL ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALDT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-695-1227
Mailing Address - Street 1:1180 COMMERCE DRIVE #14222
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8255
Mailing Address - Country:US
Mailing Address - Phone:505-695-1227
Mailing Address - Fax:877-532-2113
Practice Address - Street 1:2900 HILLRISE DRIVE
Practice Address - Street 2:2900 HILLRISE DRIVE
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011
Practice Address - Country:US
Practice Address - Phone:505-695-1227
Practice Address - Fax:877-532-2113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA108118Medicare PIN
PAU97494Medicare UPIN