Provider Demographics
NPI:1154350205
Name:TAOS CLINIC FOR CHILDREN AND YOUTH
Entity type:Organization
Organization Name:TAOS CLINIC FOR CHILDREN AND YOUTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHLARBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-758-8651
Mailing Address - Street 1:1393 WEIMER ROAD
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6253
Mailing Address - Country:US
Mailing Address - Phone:575-758-8651
Mailing Address - Fax:575-758-7811
Practice Address - Street 1:1393 WEIMER RD
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6253
Practice Address - Country:US
Practice Address - Phone:575-758-8651
Practice Address - Fax:575-758-7811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2011-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty