Provider Demographics
NPI:1588730360
Name:AFTER HOURS PEDIATRICS PC
Entity type:Organization
Organization Name:AFTER HOURS PEDIATRICS PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:HAWK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-298-2505
Mailing Address - Street 1:9201 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2468
Mailing Address - Country:US
Mailing Address - Phone:505-298-2505
Mailing Address - Fax:505-298-2985
Practice Address - Street 1:9201 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 201
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2468
Practice Address - Country:US
Practice Address - Phone:505-298-2505
Practice Address - Fax:505-298-2985
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0001644Medicaid