Provider Demographics
NPI:1740964923
Name:MINDREMEDI LLC
Entity type:Organization
Organization Name:MINDREMEDI LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BILLING/CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ARMENTA
Authorized Official - Suffix:
Authorized Official - Credentials:CPB
Authorized Official - Phone:228-334-6609
Mailing Address - Street 1:500 4TH ST NW STE 102
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2104
Mailing Address - Country:US
Mailing Address - Phone:707-639-3463
Mailing Address - Fax:
Practice Address - Street 1:500 4TH ST NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-5324
Practice Address - Country:US
Practice Address - Phone:707-639-3463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-09
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty