Provider Demographics
NPI:1851575914
Name:HEALTHNET MEDICAL FAMILY & INTERNAL MEDICINE
Entity Type:Organization
Organization Name:HEALTHNET MEDICAL FAMILY & INTERNAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:575-589-1552
Mailing Address - Street 1:1074 COUNTRY CLUB RD. BLDG C
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SANTA TERESA
Mailing Address - State:NM
Mailing Address - Zip Code:88008
Mailing Address - Country:US
Mailing Address - Phone:575-589-1552
Mailing Address - Fax:575-589-0888
Practice Address - Street 1:1074 COUNTRY CLUB RD BLDG C
Practice Address - Street 2:SUITE 1
Practice Address - City:SANTA TERESA
Practice Address - State:NM
Practice Address - Zip Code:88008-9757
Practice Address - Country:US
Practice Address - Phone:575-589-1552
Practice Address - Fax:575-589-0888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA129705208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty