Provider Demographics
NPI:1255455234
Name:SANDIA HEALTH INSTITUTE PC
Entity type:Organization
Organization Name:SANDIA HEALTH INSTITUTE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:NGOC
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-217-4029
Mailing Address - Street 1:3900 EUBANK BLVD NE
Mailing Address - Street 2:STE 18
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-3427
Mailing Address - Country:US
Mailing Address - Phone:505-881-1585
Mailing Address - Fax:505-828-3901
Practice Address - Street 1:3900 EUBANK BLVD NE
Practice Address - Street 2:STE 18
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-3427
Practice Address - Country:US
Practice Address - Phone:505-881-1585
Practice Address - Fax:505-828-3901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM287213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM213E00000XMedicaid
NM400521186Medicare Oscar/Certification
NM5337020001Medicare NSC