Provider Demographics
NPI:1639456973
Name:PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC
Entity Type:Organization
Organization Name:PHYSICIAN SURGERY CENTER OF ALBUQUERQUE LLC
Other - Org Name:POSC OF ABQ LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:TEAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-346-0500
Mailing Address - Street 1:9551 PASEO DEL NORTE NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-2976
Mailing Address - Country:US
Mailing Address - Phone:505-346-0500
Mailing Address - Fax:505-346-0164
Practice Address - Street 1:9551 PASEO DEL NORTE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-2975
Practice Address - Country:US
Practice Address - Phone:505-346-0500
Practice Address - Fax:505-346-0164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-15
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical