Provider Demographics
NPI:1972941474
Name:SPINE AND ORTHOPEDIC CENTER OF NEW MEXICO PC
Entity Type:Organization
Organization Name:SPINE AND ORTHOPEDIC CENTER OF NEW MEXICO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:NIZAR
Authorized Official - Last Name:OSMANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-623-9101
Mailing Address - Street 1:400 N PENNSYLVANIA AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-4754
Mailing Address - Country:US
Mailing Address - Phone:575-623-9101
Mailing Address - Fax:575-623-3020
Practice Address - Street 1:400 N PENNSYLVANIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-4754
Practice Address - Country:US
Practice Address - Phone:575-623-9101
Practice Address - Fax:575-623-3020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-06
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0310207X00000X, 207XS0114X, 207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No207XS0114XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryAdult Reconstructive Orthopaedic SurgeryGroup - Multi-Specialty
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM311835Medicare PIN
NM7234350001Medicare NSC