Provider Demographics
NPI:1083483895
Name:WELSCARE OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:WELSCARE OF NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:PIKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-982-6734
Mailing Address - Street 1:1250 E 3900 S STE 440
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1349
Mailing Address - Country:US
Mailing Address - Phone:801-869-4100
Mailing Address - Fax:
Practice Address - Street 1:4700 JEFFERSON ST NE STE 800
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2132
Practice Address - Country:US
Practice Address - Phone:801-869-4100
Practice Address - Fax:801-869-4119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-21
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty