| Kim Cantrell, Llc | |
|
2006 Southern Blvd Se Ste 203c Rio Rancho NM 87124-3758 | |
| (505) 362-3515 | |
| Not Available |
| Full Name | Kim Cantrell, Llc |
|---|---|
| Speciality | Social Worker |
| Location | 2006 Southern Blvd Se Ste 203c, Rio Rancho, New Mexico |
| Authorized Official Name and Position | Kim Cantrell (OWNER) |
| Authorized Official Contact | 5053623515 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kim Cantrell, Llc 8205 Spain Rd Ne Suite 106 Albuquerque NM 87109-3179 Ph: (505) 362-3515 | Kim Cantrell, Llc 2006 Southern Blvd Se Ste 203c Rio Rancho NM 87124-3758 Ph: (505) 362-3515 |
| NPI Number | 1700126794 |
|---|---|
| Provider Enumeration Date | 02/27/2013 |
| Last Update Date | 02/27/2013 |
| Medicare PECOS PAC ID | 9931342300 |
|---|---|
| Medicare Enrollment ID | O20130904000375 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700126794 | NPI | - | NPPES |
| 99976307 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | I-06910 (New Mexico) | Primary |
| Provider Name | Kimberly H Cantrell |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1326288804 PECOS PAC ID: 5698948024 Enrollment ID: I20111101000154 |
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