Provider Demographics
NPI:1942455910
Name:ALBUQUERQUE ASSOCIATED PODIATRISTS
Entity Type:Organization
Organization Name:ALBUQUERQUE ASSOCIATED PODIATRISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-247-4164
Mailing Address - Street 1:8080 ACADEMY RD NE STE C
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1110
Mailing Address - Country:US
Mailing Address - Phone:505-247-4164
Mailing Address - Fax:505-247-4561
Practice Address - Street 1:8080 ACADEMY RD NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1110
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:2008-11-18
Last Update Date:2012-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM308213ES0103X
NM325213ES0103X
NMNM181213ES0103X
NM136213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM054114Medicaid
NM6203220001Medicare NSC
NMNMB2174Medicare PIN