Provider Demographics
NPI:1043329139
Name:NORTHERN NEW MEXICOORTHOPAEDIC CENTER,PC
Entity Type:Organization
Organization Name:NORTHERN NEW MEXICOORTHOPAEDIC CENTER,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:K
Authorized Official - Last Name:AUGE
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:505-747-4144
Mailing Address - Street 1:1009 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:ESPANOLA
Mailing Address - State:NM
Mailing Address - Zip Code:87532-2740
Mailing Address - Country:US
Mailing Address - Phone:505-747-4144
Mailing Address - Fax:505-747-3213
Practice Address - Street 1:1009 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:ESPANOLA
Practice Address - State:NM
Practice Address - Zip Code:87532-2740
Practice Address - Country:US
Practice Address - Phone:505-747-4144
Practice Address - Fax:505-747-3213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM174400000X, 213ES0103X, 363AM0700X, 363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Not Answered213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMS6078Medicaid
NM=========Medicare ID - Type Unspecified
NMX2778Medicare UPIN