Corrales Family Practice LLC
Organization Active NPI Family Medicine Physician · Corrales, NM
NPI 1043401508 · NPPES record last updated Jun 12, 2008
Key facts
- NPI
- 1043401508
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 86346 (NM)
- Legal business name
- CORRALES FAMILY PRACTICE LLC
- Practice address
- 3841 Corrales Rd
Corrales, NM 87048-9311 - Phone
- (505) 792-3065
- Fax
- (505) 792-4004
- NPI assigned
- Aug 8, 2007
- Organization subpart
- No
Authorized official
- Name
- Ms. Alyson P Thal, M.D.
- Title
- Owner
- Phone
- (505) 792-3065
Practitioners 2
-
Alyson P Thal, M.D.
-
Sheila Mae Talido Kourakos, MSN, APRN, FNP-C
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D1006990 | Corrales Family Practice LLC | Provider-performed microscopy | Jun 18, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20100513000686 | NM | Part B Supplier - Clinic/Group Practice | 7618005588 |
Receives reassigned benefits from 1 practitioner Practice locations: Corrales, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician |
207Q00000X | 86346 | NM | Yes |
Addresses
Primary practice location
3841 Corrales Rd
Corrales, NM 87048-9311
Mailing address
3841 Corrales Rd
Corrales, NM 87048-9311
Phone (505) 792-3065
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 34224801 | Medicaid | NM |
Other providers in Corrales, NM
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- Angelique S Cook Lowry
- Corrales Chiropractic
- Corrales Therapy LLC
- Corrales Voice & Speech Therapy, LLC
- Jay Patrick Crowe
- Darren Braude, MD, LLC
- Catherine C Davis
All providers in Corrales, NM · Family Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 12, 2008. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.