Provider Demographics
NPI: | 1750478384 |
---|---|
Name: | SMART HEALTH INC |
Entity Type: | Organization |
Organization Name: | SMART HEALTH INC |
Other - Org Name: | NOB HILL ACUPUNCTURE |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | PRESIDENT |
Authorized Official - Prefix: | DR |
Authorized Official - First Name: | SUZANNE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | SMART |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | DOM |
Authorized Official - Phone: | 505-265-5087 |
Mailing Address - Street 1: | 3415 SILVER AVE SE |
Mailing Address - Street 2: | |
Mailing Address - City: | ALBUQUERQUE |
Mailing Address - State: | NM |
Mailing Address - Zip Code: | 87106-1438 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 505-265-5087 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 3415 SILVER AVE SE |
Practice Address - Street 2: | |
Practice Address - City: | ALBUQUERQUE |
Practice Address - State: | NM |
Practice Address - Zip Code: | 87106-1438 |
Practice Address - Country: | US |
Practice Address - Phone: | 505-265-5087 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-10-06 |
Last Update Date: | 2022-07-21 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
NM | 467RX2 | 171100000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 171100000X | Other Service Providers | Acupuncturist | Group - Single Specialty |