Provider Demographics
NPI:1598933145
Name:HEAD AND NECK SURGEONS OF NEW MEXICO, LLC
Entity Type:Organization
Organization Name:HEAD AND NECK SURGEONS OF NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ALLYSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-848-3124
Mailing Address - Street 1:1020 TIJERAS AVE NE
Mailing Address - Street 2:STE 22
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4749
Mailing Address - Country:US
Mailing Address - Phone:505-848-3124
Mailing Address - Fax:505-848-8077
Practice Address - Street 1:1020 TIJERAS AVE NE
Practice Address - Street 2:STE 22
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4749
Practice Address - Country:US
Practice Address - Phone:505-848-3124
Practice Address - Fax:505-848-8077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-18
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-130174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1598933145OtherNATIONAL PROVIDER IDENTIF