| NPI | 1235954389 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CHANCE BASINGER Manager 505-320-9952 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QU0200X Clinic/Center, Urgent Care |
| Additional Taxonomies | 207QG0300X Family Medicine, Geriatric Medicine |
| 363A00000X Physician Assistant | |
| 363AM0700X Physician Assistant, Medical | |
| 261Q00000X Clinic/Center | |
| 363L00000X Nurse Practitioner | |
| 2084B0040X Psychiatry & Neurology, Behavioral Neurology & Neuropsychiatry | |
| Enumeration Date | 2024-11-22 |
| Last Update Date | 2025-10-09 |