1831104215 NPI number — ANESTHESIA SPECIALISTS OF ALBUQUERQUE

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 1831104215 NPI number — ANESTHESIA SPECIALISTS OF ALBUQUERQUE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA SPECIALISTS OF ALBUQUERQUE
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:
1831104215
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 36840
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:
87176-6840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-243-7729
Provider Business Mailing Address Fax Number:
505-243-4804

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 MASTHEAD ST NE
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87109-4327
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-243-7729
Provider Business Practice Location Address Fax Number:
505-243-4804
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BUSICK
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
505-243-7729

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , 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)

  • Identifier: 44354 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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