Provider Demographics
NPI:1508161936
Name:NEW MEXICO SURGICAL ASSISTING, INC
Entity Type:Organization
Organization Name:NEW MEXICO SURGICAL ASSISTING, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:VALERIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-991-5713
Mailing Address - Street 1:PO BOX 23974
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-3974
Mailing Address - Country:US
Mailing Address - Phone:505-463-5645
Mailing Address - Fax:888-816-6104
Practice Address - Street 1:1505 KACHINA RIDGE DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-5172
Practice Address - Country:US
Practice Address - Phone:505-463-5645
Practice Address - Fax:888-816-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-15
Last Update Date:2011-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2005-0035363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgicalGroup - Single Specialty