1912900754 NPI number — ANESTHESIA ASSOCIATES OF NEW MEXICO P C

Table of content: (NPI 1912900754)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912900754 NPI number — ANESTHESIA ASSOCIATES OF NEW MEXICO P C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANESTHESIA ASSOCIATES OF NEW MEXICO P C
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:
1912900754
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1720 LOUISIANA BLVD NE
Provider Second Line Business Mailing Address:
STE 401
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87110-7020
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-260-4300
Provider Business Mailing Address Fax Number:
505-260-4338

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 CENTRAL AVE SE
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:
87106-4930
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-841-1234
Provider Business Practice Location Address Fax Number:
505-841-1956
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MANNE
Authorized Official First Name:
KISHORE
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
505-260-4300

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  PT0002685 , 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: 0747917 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 94001930 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 002 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 51227 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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