Rio Grande Internal Medicine PC

Primary specialty

Medical Specialty Clinic/CenterTaxonomy code 261QM2500X

License

97251 Issued in NM

Legal business name

RIO GRANDE INTERNAL MEDICINE PC

Practice address

4801 McMahon Blvd NW
Suite 235
Albuquerque, NM 87114-5090

Phone

(505) 792-2636

Fax

(505) 234-1707

NPI assigned

Feb 22, 2011

Last updated

Oct 19, 2011By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Kevin J Goodluck, MD

Title

President

Phone

(505) 792-2636

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1298332800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1318982400000",
    "number": "1750688032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 MCMAHON BLVD NW",
            "address_2": "SUITE 235",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145090",
            "telephone_number": "505-792-2636",
            "fax_number": "505-234-1707"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4801 MCMAHON BLVD NW",
            "address_2": "SUITE 235",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871145090",
            "telephone_number": "505-792-2636",
            "fax_number": "505-234-1707"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIO GRANDE INTERNAL MEDICINE PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-02-22",
        "last_updated": "2011-10-19",
        "status": "A",
        "authorized_official_last_name": "GOODLUCK",
        "authorized_official_first_name": "KEVIN",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-792-2636",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QM2500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Medical Specialty",
            "state": "NM",
            "license": "97251",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rio Grande Dermatology, PC
• Rio Grande Emdr Therapy, LLC
• Rio Grande FS, LLC (Foot Solutions)
• Rio Grande Geriatrics and Family Practice LLC
• Rio Grande Hospice LLC
• Rio Grande Mental Health PLLC
• Rio Grande Midwifery
• Rio Grande Neuroscience LLC
• Rio Grande Oral and Maxillofacial Surgery, P.C.
• Rio Grande Orthotics and Prosthetics (Advanced Prosthetics and Orthotics)

• Medical Specialty Clinic/Center in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Medical Specialty Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.