| Specialty Care Clinic Llc | |
|
3825 Eubank Blvd Ne Ste H Albuquerque NM 87111-3559 | |
| (505) 350-3397 | |
| (505) 323-7980 |
| Full Name | Specialty Care Clinic Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3825 Eubank Blvd Ne Ste H, Albuquerque, New Mexico |
| Authorized Official Name and Position | John K Jain (OWNER CEO) |
| Authorized Official Contact | 5053503397 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Specialty Care Clinic Llc 3825 Eubank Blvd Ne Ste H Albuquerque NM 87111-3559 Ph: (505) 350-3397 | Specialty Care Clinic Llc 3825 Eubank Blvd Ne Ste H Albuquerque NM 87111-3559 Ph: (505) 350-3397 |
| NPI Number | 1699517771 |
|---|---|
| Provider Enumeration Date | 06/10/2024 |
| Last Update Date | 10/07/2024 |
| Medicare PECOS PAC ID | 5496293912 |
|---|---|
| Medicare Enrollment ID | O20240815001586 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1699517771 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM1300X | Clinic/center - Multi-specialty | (* (Not Available)) | Secondary |
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Chandran Vedamanikam |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1154585990 PECOS PAC ID: 4587838784 Enrollment ID: I20111128000789 |
| Provider Name | Sarah Pack |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841853876 PECOS PAC ID: 9537550421 Enrollment ID: I20240815002544 |
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