Provider Demographics
NPI:1972548782
Name:INTERNAL MEDICINE SPECIALISTS OF ALAMOGORDO
Entity Type:Organization
Organization Name:INTERNAL MEDICINE SPECIALISTS OF ALAMOGORDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:FERIAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ABOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-439-8220
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:505-439-8220
Mailing Address - Fax:505-443-1818
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE C
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:505-439-8220
Practice Address - Fax:505-443-1818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0001261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10333061Medicaid
90052108Medicare ID - Type Unspecified
NM10333061Medicaid