Provider Demographics
NPI:1881683084
Name:NATIONAL CLINICAL TECHNOLOGY INC.
Entity Type:Organization
Organization Name:NATIONAL CLINICAL TECHNOLOGY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO/SECRETARY
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-298-1558
Mailing Address - Street 1:10400 ACADEMY RD NE
Mailing Address - Street 2:SUITE 230
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1229
Mailing Address - Country:US
Mailing Address - Phone:505-298-1558
Mailing Address - Fax:505-298-7012
Practice Address - Street 1:10400 ACADEMY RD NE
Practice Address - Street 2:SUITE 230
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111
Practice Address - Country:US
Practice Address - Phone:505-298-1558
Practice Address - Fax:505-298-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2018-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99772247200000X
NM29125247200000X
NM23040247200000X
OH19990247200000X
GA28300247200000X
AZ5256021247200000X
NM81589247200000X
NM102014247200000X
NM79471247200000X
NM129441247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, OtherGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM68312Medicaid
AZ712746Medicaid
NMNM007782OtherBC/BS OF NM
GA47BBBNNOtherMEDICARE ID-UNSPECIFIED
AZ712746Medicaid
AZ79663Medicare ID - Type Unspecified
AZ712746Medicaid