Provider Demographics
NPI:1760840615
Name:KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC
Entity Type:Organization
Organization Name:KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NDUKA-OBI
Authorized Official - Middle Name:FRANCIS
Authorized Official - Last Name:OSSAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:520-270-7348
Mailing Address - Street 1:3107 MOONLIGHT RIDGE ARC
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-1639
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3107 MOONLIGHT RIDGE ARC
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-1639
Practice Address - Country:US
Practice Address - Phone:520-270-7348
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-0631207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty