Provider Demographics
NPI:1891380085
Name:SANDIA FOOT & ANKLE OF ALBUQUERQUE PC
Entity Type:Organization
Organization Name:SANDIA FOOT & ANKLE OF ALBUQUERQUE PC
Other - Org Name:SANDIA FOOT & ANKLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:TENNY
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-717-1274
Mailing Address - Street 1:8300 CARMEL AVE NE STE 501
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87122-3125
Mailing Address - Country:US
Mailing Address - Phone:505-717-1274
Mailing Address - Fax:505-717-1879
Practice Address - Street 1:8300 CARMEL AVE NE STE 501
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87122-3125
Practice Address - Country:US
Practice Address - Phone:505-717-1274
Practice Address - Fax:505-717-1879
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-09
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty