Provider Demographics
NPI:1194422832
Name:TWILIGHT PHYSICIAN GROUP
Entity type:Organization
Organization Name:TWILIGHT PHYSICIAN GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:IRWIN-PODLESNY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-512-1880
Mailing Address - Street 1:4273 MONTGOMERY BLVD NE STE 110
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-6746
Mailing Address - Country:US
Mailing Address - Phone:505-512-1880
Mailing Address - Fax:866-502-2372
Practice Address - Street 1:4273 MONTGOMERY BLVD NE STE 110
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-6746
Practice Address - Country:US
Practice Address - Phone:505-512-1880
Practice Address - Fax:866-502-2372
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE WILLOW FOUNDATION INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-13
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural HealthGroup - Multi-Specialty