1. Home
  2. Directory
  3. New Mexico
  4. Albuquerque
  5. Family Medicine
  6. NPI Profile
  7. NPI Record 1124744909

PHOENIX PEDIATRICS LLC
Complete NPI Record 1124744909
Family Medicine in Albuquerque, NM

NPI Status: Active since October 13, 2022

Contact Information

4233 MONTGOMERY BLVD NE STE 140
ALBUQUERQUE, NM
ZIP 87109
Phone: (505) 247-1471

Get Directions

Table of Contents

  1. NPI
  2. Entity Type Code
  3. Employer Identification Number EIN
  4. Provider Organization Name Legal Business Name
  5. Provider First Line Business Mailing Address
  6. Provider Business Mailing Address City Name
  7. Provider Business Mailing Address State Name
  8. Provider Business Mailing Address Postal Code
  9. Provider Business Mailing Address Country Code If outside U S
  10. Provider Business Mailing Address Telephone Number
  11. Provider First Line Business Practice Location Address
  12. Provider Business Practice Location Address City Name
  13. Provider Business Practice Location Address State Name
  14. Provider Business Practice Location Address Postal Code
  15. Provider Business Practice Location Address Country Code If outside U S
  16. Provider Business Practice Location Address Telephone Number
  17. Provider Enumeration Date
  18. Last Update Date
  19. Authorized Official Last Name
  20. Authorized Official First Name
  21. Authorized Official Title or Position
  22. Authorized Official Telephone Number
  23. Healthcare Provider Taxonomy Code 1
  24. Healthcare Provider Primary Taxonomy Switch 1
  25. Is Organization Subpart
  26. Authorized Official Credential Text
  27. Healthcare Provider Taxonomy Group 1
  28. NPI Certification Date

Complete NPI Dataset

This page represents the complete record for NPI 1124744909. You can access the complete dataset, including a full list of field names, along with their values, and definitions as recorded by the NPI registry. Each field in the NPI record is explained, highlighting its significance and the possible values it can hold.

NPI: 1124744909
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Entity Type Code: 2
The last name of the provider. If the provider is an individual, this is the legal name.
Employer Identification Number EIN: UNAVAIL
The first name of the provider, if the provider is an individual.
The middle name of the provider, if the provider is an individual.
Provider First Line Business Mailing Address: 4233 MONTGOMERY BLVD NE STE 140
The name prefix or salutation of the provider if the provider is an individual; for example, Mr., Mrs., or Corporal.
Provider Business Mailing Address City Name: ALBUQUERQUE
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Mailing Address State Name: NM
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
Provider Business Mailing Address Postal Code: 871096707
The country code in the location address of the provider being identified.
Provider Business Mailing Address Country Code If outside U S : US
The country code in the mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address country code’’.
Provider Business Mailing Address Telephone Number: 5052471471
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Provider First Line Business Practice Location Address: 4233 MONTGOMERY BLVD NE STE 140
The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
Provider Business Practice Location Address City Name: ALBUQUERQUE
The city name in the location address of the provider being identified.
Provider Business Practice Location Address State Name: NM
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
Provider Business Practice Location Address Postal Code: 871096707
The middle name of the provider, if the provider is an individual.
Provider Business Practice Location Address Country Code If outside U S : US
The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
Provider Business Practice Location Address Telephone Number: 5052471471
The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with ‘‘provider taxonomy code’’.
Provider Enumeration Date: 10/13/2022
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
Last Update Date: 10/13/2022
Authorized Official Last Name: CHAVEZ
The first line mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider first line location address’’.
Authorized Official First Name: LENA
The telephone number associated with the location address of the provider being identified.
Authorized Official Title or Position: OWNER
The date the provider was assigned a unique identifier (assigned an NPI).
Authorized Official Telephone Number: 5052471471
The date that a record was last updated or changed.
Healthcare Provider Taxonomy Code 1: 207Q00000X
The telephone number associated with mailing address of the provider being identified. This data element may contain the same information as ‘‘Provider location address telephone number’’.
Healthcare Provider Primary Taxonomy Switch 1: Y
Code designating the provider type, classification, and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1.
Is Organization Subpart: N
The State code in the location of the provider being identified.
Authorized Official Credential Text: FNP
The code representing the State that issued the license to the provider being identified. This field can accommodate multiple States. It is associated with ‘‘provider license number.
Healthcare Provider Taxonomy Group 1: 193400000X SINGLE SPECIALTY GROUP
NPI Certification Date: 10/13/2022