505 Diagnostics LLC
Organization Active NPI Clinical Psychologist · Albuquerque, NM
NPI 1629810486 · NPPES record last updated Feb 4, 2025
Key facts
- NPI
- 1629810486
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Clinical Psychologist 103TC0700X
- Legal business name
- 505 DIAGNOSTICS LLC
- Practice address
- 4225 Montgomery Blvd NE
Albuquerque, NM 87109-1103 - Phone
- (505) 361-1931
- Fax
- (505) 521-5147
- NPI assigned
- Jun 11, 2024
- Organization subpart
- No
Authorized official
- Name
- Dr. Rebekah Jan Hutchins Khan
- Title
- Ceo/Provider
- Phone
- (470) 728-9352
Practitioners 2
-
Kenneth Gilman, PHD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20241008000079 | NM | Part B Supplier - Clinic/Group Practice | 6709317316 |
Receives reassigned benefits from 1 practitioner Practice locations: Albuquerque, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor |
101YP2500X | |||
| Clinical Psychologist |
103TC0700X | Yes |
Addresses
Primary practice location
4225 Montgomery Blvd NE
Albuquerque, NM 87109-1103
Mailing address
4225 Montgomery Blvd NE
Albuquerque, NM 87109-1103
Phone (505) 548-8035
Other providers in Albuquerque, NM
- 360Carexllc
- 369 Albuquerque Ops LLC
- 377TH Medgrp-Kirtland
- 3H Integrated, LLC
- 505 Dental LLC
- 505 Eyecare, LLC
- 505 Foot Care LLC
- 505 Therapy LLC
- 5123 Juan Tabo Boulevard NE Opco, LLC
- 5900 Forest Hills Drive NE Opco, LLC
All providers in Albuquerque, NM · Clinical Psychologist 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 Feb 4, 2025. 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.