Individual ProviderPhillip SandovalInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4901 Lang Ave NE, Albuquerque, NM 87109-4495(505) 842-8171(505) 272-1476PECOS EnrollmentBased on the most recent information from CMS, provider Phillip Sandoval is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.Part BMedicare Part BEnrolledHHAHome Health AgencyEnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 5 days ago.Profile DetailsProvider ID1427123033Provider TypeIndividualFull NameSandoval, PhillipCredentialMDGenderMaleSole ProprietorNoEnumeration Date11/21/2006Last Updated10/21/2024Contact InformationPractice LocationPractice Address4901 Lang Ave NE, Albuquerque, NM 87109-4495Phone(505) 842-8171Fax(505) 246-0684Mailing LocationMailing Address800 Bradbury Dr SE Ste 116, Albuquerque, NM 87106-4310Phone(505) 272-1476Fax(505) 246-0684Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense97359New MexicoProvider IdentifiersIDDescriptionIssuerID55379DescriptionMedicaidIssuerUnlistedNew Mexico