Provider Demographics
NPI:1558502427
Name:ALBUQUERQUE VEIN & LASER INSTITUTE
Entity Type:Organization
Organization Name:ALBUQUERQUE VEIN & LASER INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GLENN
Authorized Official - Last Name:CUTCHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-507-4934
Mailing Address - Street 1:7401 HANCOCK CT NE
Mailing Address - Street 2:SUITE A
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4593
Mailing Address - Country:US
Mailing Address - Phone:505-848-8346
Mailing Address - Fax:505-848-8345
Practice Address - Street 1:7401 HANCOCK CT NE
Practice Address - Street 2:SUITE A
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4593
Practice Address - Country:US
Practice Address - Phone:505-848-8346
Practice Address - Fax:505-848-8345
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2005-0798261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI61645Medicare UPIN