Provider Demographics
NPI:1831306570
Name:SANDIA OBGYN ASSOCIATES
Entity Type:Organization
Organization Name:SANDIA OBGYN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:CONNORS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-727-3280
Mailing Address - Street 1:4705 MONTGOMERY BLVD NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-1226
Mailing Address - Country:US
Mailing Address - Phone:505-727-3280
Mailing Address - Fax:505-727-3282
Practice Address - Street 1:4705 MONTGOMERY BLVD NE
Practice Address - Street 2:SUITE 105
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-1226
Practice Address - Country:US
Practice Address - Phone:505-727-3280
Practice Address - Fax:505-727-3282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA913-90207VX0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM201001970OtherMOLINA HEALTHCARE
NMF8452Medicaid
NMNM004926OtherBCBS -HMO OF NEW MEXICO
NM=========OtherALL OTHER HEALTH PLANS
NME79131Medicare UPIN
NM200521024Medicare ID - Type UnspecifiedMEDICARE
NM201001970OtherMOLINA HEALTHCARE