Provider Demographics
NPI:1629803192
Name:REFORM ABQ
Entity type:Organization
Organization Name:REFORM ABQ
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:M
Authorized Official - Last Name:CAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-421-9316
Mailing Address - Street 1:200 OAK ST NE STE 7
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4353
Mailing Address - Country:US
Mailing Address - Phone:505-420-6979
Mailing Address - Fax:
Practice Address - Street 1:200 OAK ST NE STE 7
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4353
Practice Address - Country:US
Practice Address - Phone:505-420-6979
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical SpecialtyGroup - Multi-Specialty
No251J00000XAgenciesNursing Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Multi-Specialty