Provider Demographics
NPI:1831109560
Name:NEW MEXICO ORTHOPAEDIC SURGERY CENTER, LLC
Entity Type:Organization
Organization Name:NEW MEXICO ORTHOPAEDIC SURGERY CENTER, LLC
Other - Org Name:NEW MEXICO SURGERY CENTER ORTHOPAEDICS
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RENEE
Authorized Official - Middle Name:
Authorized Official - Last Name:AGUILAR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:505-291-2340
Mailing Address - Street 1:8300 CONSTITUTION AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7613
Mailing Address - Country:US
Mailing Address - Phone:505-357-3072
Mailing Address - Fax:505-213-0583
Practice Address - Street 1:8300 CONSTITUTION AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7613
Practice Address - Country:US
Practice Address - Phone:505-291-2300
Practice Address - Fax:505-291-2299
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3002261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00062743Medicaid
NMSS23OtherBLUE CROSS BLUE SHIELD
NM490004602OtherRAILROAD MEDICARE
NMSS23OtherBLUE CROSS BLUE SHIELD
NM00062743Medicaid