Provider Demographics
NPI:1790507531
Name:HEARTLAND CLINICS OF NEW MEXICO, INC
Entity type:Organization
Organization Name:HEARTLAND CLINICS OF NEW MEXICO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-207-4224
Mailing Address - Street 1:667 BARTRAM DOWNS RD # 667
Mailing Address - Street 2:
Mailing Address - City:ORANGE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32065-8231
Mailing Address - Country:US
Mailing Address - Phone:904-207-4224
Mailing Address - Fax:
Practice Address - Street 1:609 BROADWAY BLVD NE # 100
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-9804
Practice Address - Country:US
Practice Address - Phone:904-207-4224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No251K00000XAgenciesPublic Health or Welfare
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health