Provider Demographics
NPI:1508574724
Name:NEW MEXICO VASCULAR CONSULTING LLC
Entity Type:Organization
Organization Name:NEW MEXICO VASCULAR CONSULTING LLC
Other - Org Name:SONORAN VEIN & ENDOVASCULAR, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NYE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:480-363-7778
Mailing Address - Street 1:2487 S GILBERT RD STE 106-431
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85295-2825
Mailing Address - Country:US
Mailing Address - Phone:480-363-7778
Mailing Address - Fax:
Practice Address - Street 1:1551 S SECOND ST
Practice Address - Street 2:
Practice Address - City:GALLUP
Practice Address - State:NM
Practice Address - Zip Code:87301-5881
Practice Address - Country:US
Practice Address - Phone:505-542-0090
Practice Address - Fax:505-542-0155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-07
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty