Provider Demographics
NPI:1649583477
Name:AIDMED INC
Entity Type:Organization
Organization Name:AIDMED INC
Other - Org Name:PATHOLOGY CONSULTANTS OF NEW MEXICO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-895-8303
Mailing Address - Street 1:11490 BURBANK BLVD
Mailing Address - Street 2:STE 1D
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91601-2389
Mailing Address - Country:US
Mailing Address - Phone:877-895-8303
Mailing Address - Fax:
Practice Address - Street 1:600 N RICHARDSON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4828
Practice Address - Country:US
Practice Address - Phone:877-895-8303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32D0537453291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory