Provider Demographics
NPI:1205878758
Name:ALBUQUERQUE AMBULATORY EYE SURGERY CENTER, LLC
Entity type:Organization
Organization Name:ALBUQUERQUE AMBULATORY EYE SURGERY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:E
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-246-2622
Mailing Address - Street 1:PO BOX 90550
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87199-0550
Mailing Address - Country:US
Mailing Address - Phone:505-768-1333
Mailing Address - Fax:505-244-9566
Practice Address - Street 1:5901 HARPER DR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-3587
Practice Address - Country:US
Practice Address - Phone:505-823-8545
Practice Address - Fax:505-823-8549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2014-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3087261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM154528701OtherTEXAS MEDICAID
NM490005505OtherRRB RAILROAD MEDICARE
NM28957512OtherCOLORADO MEDICAID
NMNM00SS87OtherBCBSNM
NM741597OtherARIZONA MEDICAID
NM34301364Medicaid
NMNM00SS87OtherBCBSNM