1548264351 NPI number — PREMIER ANESTHESIA OF NEW MEXICO, LLP

Table of content: DR. ASHLEY STEIN ARAIZA D.D.S (NPI 1215375852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548264351 NPI number — PREMIER ANESTHESIA OF NEW MEXICO, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER ANESTHESIA OF NEW MEXICO, LLP
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:
1548264351
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 52194
Provider Second Line Business Mailing Address:
DEPT 987
Provider Business Mailing Address City Name:
PHOENIX
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85072-2194
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-532-7000
Provider Business Mailing Address Fax Number:
575-532-7006

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1720 WYOMING BLVD NE
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:
87112-3855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-292-9200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
TRACY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-292-9200

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NM007G66 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 78986575 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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