Provider Demographics
NPI:1346242575
Name:NEW MEXICO HEART INSTITUTE, LLC
Entity Type:Organization
Organization Name:NEW MEXICO HEART INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EVP, GENERAL COUNSEL
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:
Authorized Official - Last Name:PETROVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-296-3594
Mailing Address - Street 1:502 ELM ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2512
Mailing Address - Country:US
Mailing Address - Phone:505-841-1000
Mailing Address - Fax:505-843-2956
Practice Address - Street 1:502 ELM ST. NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102
Practice Address - Country:US
Practice Address - Phone:505-841-1000
Practice Address - Fax:505-843-2956
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LOVELACE HEALTH SYSTEMS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-01
Last Update Date:2019-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMFA0003020207RC0000X, 208G00000X
207RC0000X, 208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMFA0003020 PT0002833OtherNMHI BUSINESS REGISTRATIO
NMH5743Medicaid
NM2370703Medicare PIN