NPIMap

Organization Active NPI

Minuteclinic Diagnostic of New Mexico, LLC

  • Family Nurse Practitioner
  • Albuquerque, NM
National Provider Identifier
1740601012
Registry record updated Mar 4, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
Legal business name
MINUTECLINIC DIAGNOSTIC OF NEW MEXICO, LLC
Practice address
4340 San Mateo Blvd NE
Albuquerque, NM 87110-1234
Phone
(866) 389-2727
Fax
(401) 406-3539
NPI assigned
Jan 3, 2014
Last updated
Mar 4, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 4, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deborah Pincince
Title
Administrator
Phone
(401) 770-3813

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363LF0000X Primary

Addresses

Primary practice location

4340 San Mateo Blvd NE
Albuquerque, NM 87110-1234

Mailing address

1 CVS Dr
Credentialing PO Box 772-Mc2295
Woonsocket, RI 02895-6146
Phone (866) 389-2727

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20150105000196 NM Part B Supplier - Clinic/Group Practice 7517280266 Receives reassigned benefits from 30 practitioners
Practice locations: Albuquerque, NM; Rio Rancho, NM

National Provider Directory

National Provider Directory

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Locations

4340 San Mateo Blvd NE
Albuquerque, NM 87110
Phone (505) 252-0599

9640 Menaul Blvd NE
Albuquerque, NM 87112
Phone (505) 294-4167

Practitioners & affiliated clinicians

Practitioners 31

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 31

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1388707200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1741046400000",
    "number": "1740601012",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1 CVS DR",
            "address_2": "CREDENTIALING PO BOX 772-MC2295",
            "city": "WOONSOCKET",
            "state": "RI",
            "postal_code": "028956146",
            "telephone_number": "866-389-2727",
            "fax_number": "401-406-3539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4340 SAN MATEO BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871101234",
            "telephone_number": "866-389-2727",
            "fax_number": "401-406-3539"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MINUTECLINIC DIAGNOSTIC OF NEW MEXICO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-01-03",
        "last_updated": "2025-03-04",
        "certification_date": "2025-03-04",
        "status": "A",
        "authorized_official_last_name": "PINCINCE",
        "authorized_official_first_name": "DEBORAH",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "401-770-3813"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner, Family",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.