Provider Demographics
NPI:1730172735
Name:MUGLIN LLC
Entity type:Organization
Organization Name:MUGLIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECT OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARGARET
Authorized Official - Middle Name:V
Authorized Official - Last Name:DENTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-623-4448
Mailing Address - Street 1:711 W ALAMEDA ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88203-4403
Mailing Address - Country:US
Mailing Address - Phone:505-623-4448
Mailing Address - Fax:505-623-9571
Practice Address - Street 1:711 W ALAMEDA ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-4403
Practice Address - Country:US
Practice Address - Phone:505-623-4448
Practice Address - Fax:505-623-9571
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97218207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR6548Medicaid
87726OtherUNITED HEALTHCARE
NM34732OtherPRESBYTERIAN
NM011928OtherBCBS
NM34732OtherPRESBYTERIAN