Provider Demographics
NPI:1750580411
Name:PEDIATRIX CARDIOLOGY OF NEW MEXICO, P.C.
Entity type:Organization
Organization Name:PEDIATRIX CARDIOLOGY OF NEW MEXICO, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:H
Authorized Official - Last Name:KURZWEIL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:602-256-4628
Mailing Address - Street 1:4722 N 24TH ST
Mailing Address - Street 2:STE. 150
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85016-4800
Mailing Address - Country:US
Mailing Address - Phone:602-256-4628
Mailing Address - Fax:855-851-4319
Practice Address - Street 1:201 CEDAR ST SE
Practice Address - Street 2:STE. 700
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4917
Practice Address - Country:US
Practice Address - Phone:505-848-3700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2014-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric CardiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM71032860Medicaid
NM71032860Medicaid