Provider Demographics
NPI:1407861248
Name:ALAMOGORDO SURGICAL ASSOCIATES
Entity Type:Organization
Organization Name:ALAMOGORDO SURGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:B
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-437-2244
Mailing Address - Street 1:1100 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-6414
Mailing Address - Country:US
Mailing Address - Phone:505-437-2244
Mailing Address - Fax:505-437-8000
Practice Address - Street 1:1100 10TH ST
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-6414
Practice Address - Country:US
Practice Address - Phone:505-437-2244
Practice Address - Fax:505-437-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00046391Medicaid
NM00046391Medicaid