Provider Demographics
NPI:1891011052
Name:TASKER HATCH ROWAN LLC
Entity Type:Organization
Organization Name:TASKER HATCH ROWAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EBONIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-850-3769
Mailing Address - Street 1:2801 EUBANK BLVD NE, STE J
Mailing Address - Street 2:SUITE D2
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1034
Mailing Address - Country:US
Mailing Address - Phone:505-299-9606
Mailing Address - Fax:505-299-9740
Practice Address - Street 1:2801 EUBANK BLVD NE STE J
Practice Address - Street 2:SUITE D2
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1300
Practice Address - Country:US
Practice Address - Phone:505-299-9606
Practice Address - Fax:505-299-9740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2022-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD3168122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM9221857Medicaid
NM92935001Medicaid
NM9177740Medicaid