Provider Demographics
NPI:1477111482
Name:SOUTHEAST NEW MEXICO PODIATRY ASSOCIATES INC
Entity type:Organization
Organization Name:SOUTHEAST NEW MEXICO PODIATRY ASSOCIATES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:OLGA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAGEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-885-3445
Mailing Address - Street 1:1016 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-4013
Mailing Address - Country:US
Mailing Address - Phone:575-885-3445
Mailing Address - Fax:575-887-0163
Practice Address - Street 1:5419 N LOVINGTON HWY STE 9
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9135
Practice Address - Country:US
Practice Address - Phone:575-964-8770
Practice Address - Fax:575-887-0163
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST NM PODIATRY ASSOCIATES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-06-04
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM89008863Medicaid