Provider Demographics
NPI:1679264634
Name:MICHELLE COREY ENT. INC.
Entity Type:Organization
Organization Name:MICHELLE COREY ENT. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:FMP
Authorized Official - Phone:575-613-4369
Mailing Address - Street 1:509 VISTA RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6781
Mailing Address - Country:US
Mailing Address - Phone:575-613-4369
Mailing Address - Fax:866-686-3415
Practice Address - Street 1:509 VISTA RIDGE RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6781
Practice Address - Country:US
Practice Address - Phone:575-613-4369
Practice Address - Fax:866-686-3415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service