Provider Demographics
NPI:1790019453
Name:DOCTOR ON CALL #3 LLC
Entity Type:Organization
Organization Name:DOCTOR ON CALL #3 LLC
Other - Org Name:SPINE AND PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:VIGIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-323-8911
Mailing Address - Street 1:10700 MENAUL BLVD NE
Mailing Address - Street 2:SUITE D
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2437
Mailing Address - Country:US
Mailing Address - Phone:505-275-4972
Mailing Address - Fax:505-294-3305
Practice Address - Street 1:10700 MENAUL BLVD NE
Practice Address - Street 2:SUITE D
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-2437
Practice Address - Country:US
Practice Address - Phone:505-275-4972
Practice Address - Fax:505-294-3305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-29
Last Update Date:2009-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty