Provider Demographics
NPI:1396705687
Name:RIO WEST MEDICAL, LLC
Entity type:Organization
Organization Name:RIO WEST MEDICAL, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:
Authorized Official - Last Name:YAUK
Authorized Official - Suffix:
Authorized Official - Credentials:C PED
Authorized Official - Phone:505-896-0533
Mailing Address - Street 1:PO BOX 44787
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87174-4787
Mailing Address - Country:US
Mailing Address - Phone:505-896-0533
Mailing Address - Fax:505-896-0522
Practice Address - Street 1:6200 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87120-2785
Practice Address - Country:US
Practice Address - Phone:505-896-0533
Practice Address - Fax:505-896-0522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-23
Last Update Date:2008-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06587577Medicaid
NM06928773Medicaid
NM202003149OtherPRESBYTERIAN NM
NMNM01TA20OtherBCBSNM
NM201065393OtherPRESBYTERIAN NM
NM06928773Medicaid
NM202003149OtherPRESBYTERIAN NM
NM5154880001Medicare PIN