Provider Demographics
NPI:1477095966
Name:SURGICAL ONCOLOGY AND GASTROINTESTINAL SURGERY CONSULTANTS, LLC
Entity Type:Organization
Organization Name:SURGICAL ONCOLOGY AND GASTROINTESTINAL SURGERY CONSULTANTS, LLC
Other - Org Name:ALBUQUERQUE UPTOWN DOCTORS HEALTHCARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIPIZ-VALLEJOS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-200-3808
Mailing Address - Street 1:6100 UPTOWN BLVD NE
Mailing Address - Street 2:STE 600
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-4163
Mailing Address - Country:US
Mailing Address - Phone:505-200-3808
Mailing Address - Fax:505-200-3807
Practice Address - Street 1:6100 UPTOWN BLVD NE
Practice Address - Street 2:STE 600
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4163
Practice Address - Country:US
Practice Address - Phone:505-200-3808
Practice Address - Fax:505-200-3807
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SURGIVAL ONCOLOGY AND GASTROINTESTINAL SURGERY CONSULTANTS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-11-15
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMLD0825133V00000X
NM2001214208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
No133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM10626751Medicaid
NM343514Medicare UPIN