Provider Demographics
NPI:1770064743
Name:INVICTUS HEALTHCARE MANAGEMENT, LLC
Entity type:Organization
Organization Name:INVICTUS HEALTHCARE MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:MRS
Authorized Official - First Name:JASMINE
Authorized Official - Middle Name:
Authorized Official - Last Name:KIEFER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:915-525-3370
Mailing Address - Street 1:2418 E. HWY 66 PMB 496
Mailing Address - Street 2:
Mailing Address - City:GALLUP
Mailing Address - State:NM
Mailing Address - Zip Code:87301
Mailing Address - Country:US
Mailing Address - Phone:915-525-3370
Mailing Address - Fax:
Practice Address - Street 1:1901 RED ROCK DR
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5683
Practice Address - Country:US
Practice Address - Phone:505-863-7030
Practice Address - Fax:505-863-5806
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-27
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty