Provider Demographics
NPI:1851497663
Name:OPTUMCARE NEW MEXICO, LLC
Entity Type:Organization
Organization Name:OPTUMCARE NEW MEXICO, LLC
Other - Org Name:NEW MEXICO CENTER FOR SLEEP MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:G
Authorized Official - Last Name:LIETHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:952-205-6262
Mailing Address - Street 1:PO BOX 26028
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87125-6028
Mailing Address - Country:US
Mailing Address - Phone:505-872-6000
Mailing Address - Fax:505-872-6003
Practice Address - Street 1:4700 JEFFERSON ST NE
Practice Address - Street 2:SUITE 800
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2136
Practice Address - Country:US
Practice Address - Phone:505-872-6000
Practice Address - Fax:505-872-6003
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ABQ HEALTH PARTNERS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-16
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM400521253Medicare ID - Type Unspecified