Provider Demographics
NPI:1356405369
Name:ST. CHRISTOPHER INC
Entity type:Organization
Organization Name:ST. CHRISTOPHER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:K
Authorized Official - Last Name:TIERNAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-821-1146
Mailing Address - Street 1:2800 SAN MATEO BLVD NE
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-3135
Mailing Address - Country:US
Mailing Address - Phone:505-821-1146
Mailing Address - Fax:505-843-9234
Practice Address - Street 1:2800 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE 107
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-3135
Practice Address - Country:US
Practice Address - Phone:505-821-1146
Practice Address - Fax:505-843-9234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03079971006261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care