| |
6100 Uptown Blvd Ne, Ste 600, Albuquerque, NM 87110-4163 | |
(505) 200-3808 | |
(505) 200-3807 |
Full Name | |
---|---|
Type | Facility |
Speciality | Surgery |
Location | 6100 Uptown Blvd Ne, Albuquerque, New Mexico |
Accepts Medicare Assignments | Does not participate in Medicare Program. The facility may not accept medicare assignment. |
Identifier | Type | State | Issuer |
---|---|---|---|
1477095966 | NPI | - | NPPES |
10626751 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
133V00000X | Dietitian, Registered | LD0825 (New Mexico) | Secondary |
208600000X | Surgery | 2001214 (New Mexico) | Primary |
Mailing Address | Practice Location Address |
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6100 Uptown Blvd Ne, Ste 600, Albuquerque, NM 87110-4163 Ph: (505) 200-3808 | 6100 Uptown Blvd Ne, Ste 600, Albuquerque, NM 87110-4163 Ph: (505) 200-3808 |