Provider Demographics
NPI:1649374380
Name:NORTHERN NEW MEXICO SURGERY
Entity type:Organization
Organization Name:NORTHERN NEW MEXICO SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SURGEON OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:J
Authorized Official - Last Name:BARKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-661-3030
Mailing Address - Street 1:3917 WEST ROAD SUITE #125
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544
Mailing Address - Country:US
Mailing Address - Phone:505-661-3030
Mailing Address - Fax:505-662-9024
Practice Address - Street 1:3917 WEST ROAD SUITE #125
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544
Practice Address - Country:US
Practice Address - Phone:505-661-3030
Practice Address - Fax:505-662-9024
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM14874555Medicaid
F25161Medicare UPIN