Provider Demographics
NPI:1750897377
Name:NEW MEXICO KIDNEY CARE LLC
Entity type:Organization
Organization Name:NEW MEXICO KIDNEY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:HILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:704-651-0795
Mailing Address - Street 1:271 PASEO DE DIA
Mailing Address - Street 2:STE 200
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7341
Mailing Address - Country:US
Mailing Address - Phone:575-521-1575
Mailing Address - Fax:575-521-1940
Practice Address - Street 1:271 PASEO DE DIA
Practice Address - Street 2:STE 200
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7341
Practice Address - Country:US
Practice Address - Phone:575-521-1575
Practice Address - Fax:575-521-1940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-19
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36488542Medicaid