Provider Demographics
NPI:1497774574
Name:INTERNAL MEDICINE OF GRANTS
Entity type:Organization
Organization Name:INTERNAL MEDICINE OF GRANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:H
Authorized Official - Middle Name:N
Authorized Official - Last Name:AUGENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-287-2621
Mailing Address - Street 1:101 GREENLEAF CT
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-4235
Mailing Address - Country:US
Mailing Address - Phone:505-287-2621
Mailing Address - Fax:505-287-5119
Practice Address - Street 1:101 GREENLEAF CT
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-4235
Practice Address - Country:US
Practice Address - Phone:505-287-2621
Practice Address - Fax:505-287-5119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-19
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-I38174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201025858OtherPRESBYTERIAN
NM110218817OtherRAILROAD MEDICARE
NMNM-003231OtherBCBS-AUGENSTEIN
NM800522574Medicare PIN