1326570599 NPI number — NEW MEXICO FOOT AND ANKLE INSTITUTE PC

Table of content: (NPI 1326570599)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326570599 NPI number — NEW MEXICO FOOT AND ANKLE INSTITUTE PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW MEXICO FOOT AND ANKLE INSTITUTE 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:
1326570599
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4343 PAN AMERICAN FWY NE STE 234
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:
87107-6834
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-880-1000
Provider Business Mailing Address Fax Number:
505-880-1002

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10511 GOLF COURSE RD NW STE 203
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALBUQUERQUE
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87114-5917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-872-3333
Provider Business Practice Location Address Fax Number:
505-880-1002
Provider Enumeration Date:
03/28/2017

Additional Information

Authorized Official

Authorized Official Last Name:
IVEY
Authorized Official First Name:
NATHAN
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-880-1000

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08571325 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4583990001 . This is a "DMERC" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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