Provider Demographics
NPI:1922219203
Name:ALBUQUERQUE ASSOCIATED PODIATRISTS
Entity Type:Organization
Organization Name:ALBUQUERQUE ASSOCIATED PODIATRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-247-4164
Mailing Address - Street 1:121 SYCAMORE ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4622
Mailing Address - Country:US
Mailing Address - Phone:505-247-4164
Mailing Address - Fax:505-247-4561
Practice Address - Street 1:121 SYCAMORE ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4622
Practice Address - Country:US
Practice Address - Phone:505-247-4164
Practice Address - Fax:505-247-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-25
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM136213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1154320001Medicare NSC
339716503Medicare PIN