Provider Demographics
NPI:1689423279
Name:VALLEY ABORTION GROUP
Entity type:Organization
Organization Name:VALLEY ABORTION GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THANH-TAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:CNM
Authorized Official - Phone:505-221-6337
Mailing Address - Street 1:PO BOX 25002
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-0002
Mailing Address - Country:US
Mailing Address - Phone:505-221-6337
Mailing Address - Fax:
Practice Address - Street 1:8120 LA MIRADA PL NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1605
Practice Address - Country:US
Practice Address - Phone:505-221-6337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-15
Last Update Date:2024-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice MidwifeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1508165754Medicaid
NM1316254162Medicaid