Provider Demographics
NPI:1225103450
Name:NEW MEXICO FOOT AND ANKLE INSTITUTE PC
Entity Type:Organization
Organization Name:NEW MEXICO FOOT AND ANKLE INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:IVEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-880-1000
Mailing Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6834
Mailing Address - Country:US
Mailing Address - Phone:505-880-1000
Mailing Address - Fax:505-880-1002
Practice Address - Street 1:4343 PAN AMERICAN FWY NE STE 234
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6834
Practice Address - Country:US
Practice Address - Phone:505-880-1000
Practice Address - Fax:505-880-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-22
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10004402OtherLOVELACE
CK6674OtherRAILROAD MCR
NMPROVB11359OtherMOLINA
NM201042850OtherPRASBYTERIAN
NM8571325Medicaid
NMNM005490OtherBLUE CROSS BLUE SHIELD
CK6674OtherRAILROAD MCR
NM=========OtherTRICARE
NM4583990001Medicare NSC