1760840615 NPI number — KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760840615 NPI number — KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC
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:
1760840615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3107 MOONLIGHT RIDGE ARC
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88011-1639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
250 E AMADOR AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-3660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-288-2131
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
OSSAI
Authorized Official First Name:
NDUKA-OBI
Authorized Official Middle Name:
FRANCIS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-270-7348

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RN0300X , with the licence number: MD2014-0631 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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