Provider Demographics
NPI:1255373676
Name:EYE SURGERY CENTERS OF NEW MEXICO, LLC
Entity type:Organization
Organization Name:EYE SURGERY CENTERS OF NEW MEXICO, LLC
Other - Org Name:<UNAVAIL>
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 1:2947 RODEO PARK DR E
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6303
Practice Address - Country:US
Practice Address - Phone:505-474-9880
Practice Address - Fax:505-474-9881
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
NM3076261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00SS85OtherBCBSNM
NM490005504OtherRRB MEDICARE RAILROAD
NM75955717Medicaid
NM75955717Medicaid