1144516113 NPI number — NEW MEXICO ORTHOPAEDIC ASSOCIATES PC

Table of content: (NPI 1144516113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144516113 NPI number — NEW MEXICO ORTHOPAEDIC ASSOCIATES PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO ORTHOPAEDIC ASSOCIATES PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1144516113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 LOUISIANA BLVD NE STE 410
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-5412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-724-4384
Provider Business Mailing Address Fax Number:
505-724-4384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1201 RIO RANCHO BLVD SE
Provider Second Line Business Practice Location Address:
SUITE E
Provider Business Practice Location Address City Name:
RIO RANCHO
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87124
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-892-3520
Provider Business Practice Location Address Fax Number:
505-892-3521
Provider Enumeration Date:
06/28/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RACCA
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-724-4300

Provider Taxonomy Codes

  • Taxonomy code: 225100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2251H1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251S0007X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251X0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XH1200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)