Provider Demographics
NPI:1043541626
Name:TADDY HEALTHCARE SERVICES
Entity type:Organization
Organization Name:TADDY HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NII TETTEH
Authorized Official - Middle Name:TSURU
Authorized Official - Last Name:ADDY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-482-1002
Mailing Address - Street 1:615 W MERMOD ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3513
Mailing Address - Country:US
Mailing Address - Phone:575-885-7714
Mailing Address - Fax:575-885-7714
Practice Address - Street 1:615 W MERMOD ST
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-4912
Practice Address - Country:US
Practice Address - Phone:575-885-7714
Practice Address - Fax:575-885-7714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2016-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-1299-05207Q00000X, 261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty