Provider Demographics
NPI:1669551446
Name:NEW MEXICO OSTEOPOROSIS INC.
Entity type:Organization
Organization Name:NEW MEXICO OSTEOPOROSIS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:COSTALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-888-0035
Mailing Address - Street 1:4300 SAN MATEO BLVD NE
Mailing Address - Street 2:SUITE A-140
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-1229
Mailing Address - Country:US
Mailing Address - Phone:505-888-0035
Mailing Address - Fax:505-888-2002
Practice Address - Street 1:4300 SAN MATEO BLVD NE
Practice Address - Street 2:SUITE A-140
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-1229
Practice Address - Country:US
Practice Address - Phone:505-888-0035
Practice Address - Fax:505-888-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2012-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM82161174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM52526Medicaid
NM52526Medicaid
NM800521171Medicare PIN