| John R. Vigil, Md, Llc | |
|
3900 Eubank Blvd Ne Ste 18 Albuquerque NM 87111-3427 | |
| (505) 884-3344 | |
| Not Available |
| Full Name | John R. Vigil, Md, Llc |
|---|---|
| Speciality | General Practice |
| Location | 3900 Eubank Blvd Ne Ste 18, Albuquerque, New Mexico |
| Authorized Official Name and Position | Johnnie R Vigil (OWNER/MD) |
| Authorized Official Contact | 5052631422 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| John R. Vigil, Md, Llc 205 W Boutz Rd Bldg 1 Las Cruces NM 88005-3259 Ph: (575) 532-7000 | John R. Vigil, Md, Llc 3900 Eubank Blvd Ne Ste 18 Albuquerque NM 87111-3427 Ph: (505) 884-3344 |
| NPI Number | 1992084008 |
|---|---|
| Provider Enumeration Date | 08/06/2011 |
| Last Update Date | 10/05/2021 |
| Medicare PECOS PAC ID | 9830330174 |
|---|---|
| Medicare Enrollment ID | O20130729000607 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992084008 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | 89-319 (New Mexico) | Primary |
| Provider Name | Johnnie R Vigil |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1285762377 PECOS PAC ID: 2466351051 Enrollment ID: I20040102000408 |
| Provider Name | Paul E Romo |
|---|---|
| Provider Type | Practitioner - Addiction Medicine |
| Provider Identifiers | NPI Number: 1306089313 PECOS PAC ID: 2062649007 Enrollment ID: I20141014000472 |
| Provider Name | Rozita Dayani |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1932706223 PECOS PAC ID: 2567875339 Enrollment ID: I20210115001764 |
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