Provider Demographics
NPI:1932120052
Name:MEDICAL REHAB CENTER OF NEW MEXICO PA
Entity Type:Organization
Organization Name:MEDICAL REHAB CENTER OF NEW MEXICO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE TEAM LEAD
Authorized Official - Prefix:
Authorized Official - First Name:STEFANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROYCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-338-2077
Mailing Address - Street 1:3874 MASTHEAD NE
Mailing Address - Street 2:BLDG G
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4479
Mailing Address - Country:US
Mailing Address - Phone:505-338-2077
Mailing Address - Fax:505-338-1960
Practice Address - Street 1:3874 MASTHEAD NE
Practice Address - Street 2:BLDG G
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4479
Practice Address - Country:US
Practice Address - Phone:505-338-2077
Practice Address - Fax:505-338-1960
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94364208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00025532Medicaid
NME03479Medicare UPIN
NM00025532Medicaid
200521017Medicare PIN