Provider Demographics
NPI:1740237262
Name:APOGEE MEDICAL GROUP NEW MEXICO INC
Entity Type:Organization
Organization Name:APOGEE MEDICAL GROUP NEW MEXICO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:HARWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:602-778-3600
Mailing Address - Street 1:PO BOX 708850
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84070-8850
Mailing Address - Country:US
Mailing Address - Phone:801-352-9500
Mailing Address - Fax:801-352-7976
Practice Address - Street 1:15059 N SCOTTSDALE ROAD
Practice Address - Street 2:SUITE 600
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-2685
Practice Address - Country:US
Practice Address - Phone:602-778-3600
Practice Address - Fax:602-778-3695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-29
Last Update Date:2016-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM3632369Medicaid
NM96671823Medicaid
NMNM007E50OtherBCBS
NM24870889Medicaid
NMDB9470OtherRR MEDICARE
NM94888523Medicaid
NM300521042Medicare ID - Type Unspecified