Provider Demographics
NPI:1366264111
Name:DESERT WOLF HEALTHCARE LLC
Entity type:Organization
Organization Name:DESERT WOLF HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-318-0717
Mailing Address - Street 1:1510 WINDMILL CT NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5605
Mailing Address - Country:US
Mailing Address - Phone:505-459-7637
Mailing Address - Fax:505-349-0803
Practice Address - Street 1:2509 VIRGINIA ST NE STE B
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4695
Practice Address - Country:US
Practice Address - Phone:505-318-0717
Practice Address - Fax:505-349-0803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-31
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care