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LOS ALAMOS PEDIATRIC CLINIC NPI 1245248830


NPI Information

NPI: 1245248830
Provider Name: LOS ALAMOS PEDIATRIC CLINIC
Classification: Pediatrics - 208000000X
Entity Type: Organization

CLIA Number: 32D0536704

Address:
3917 WEST ROAD
SUITE 136
LOS ALAMOS, NM
ZIP 87544
Phone: (505) 662-9620
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LOS ALAMOS PEDIATRIC CLINIC is a pediatrics in Los Alamos, NM. The provider is a pediatrician is concerned with the physical, emotional and social health of children from birth to young adulthood. Care encompasses a broad spectrum of health services ranging from preventive healthcare to the diagnosis and treatment of acute and chronic diseases. A pediatrician deals with biological, social and environmental influences on the developing child, and with the impact of disease and dysfunction on development. LOS ALAMOS PEDIATRIC CLINIC NPI is 1245248830. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

3917 WEST ROAD
SUITE 136
LOS ALAMOS, NM
ZIP 87544
Phone: (505) 662-9620
Fax: (505) 662-0024

The provider's authorized official is Jacqueline Anne Krohn .
The authorized official title is President and has the following contact phone number (509) 662-9620.

The CLIA number assigned to this NPI record is 32D0536704 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/3/2006 and was last updated on 8/22/2020.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1208000000XPediatrics79195NEW MEXICOYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
111783MEDICAIDNEW MEXICO
210003513OTHERNEW MEXICOLOVELACE HEALTH
3PROVP13573OTHERNEW MEXICOMOLINA HEALTHCARE
46693OTHERNEW MEXICOHMA NAVAJO NATION
5NM011552OTHERNEW MEXICOBCBS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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