Provider Demographics
NPI:1902009756
Name:HYPERBARIC MEDICAL CENTER OF NEW MEXICO INC
Entity Type:Organization
Organization Name:HYPERBARIC MEDICAL CENTER OF NEW MEXICO INC
Other - Org Name:HMCNM
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:FIVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-955-8560
Mailing Address - Street 1:404 BRUNN SCHOOL RD
Mailing Address - Street 2:STE D E
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-1102
Mailing Address - Country:US
Mailing Address - Phone:505-955-8560
Mailing Address - Fax:505-989-1587
Practice Address - Street 1:404 BRUNN SCHOOL RD
Practice Address - Street 2:STE D E
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-1102
Practice Address - Country:US
Practice Address - Phone:505-955-8560
Practice Address - Fax:505-989-1587
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-08
Last Update Date:2007-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97382207PE0005X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0005XAllopathic & Osteopathic PhysiciansEmergency MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44875827Medicaid