Provider Demographics
NPI:1780605394
Name:ORTHOPAEDIC SPORTS MEDICINE INSTITUTE
Entity type:Organization
Organization Name:ORTHOPAEDIC SPORTS MEDICINE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KRISTINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:MARTINEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-532-9755
Mailing Address - Street 1:4351 E LOHMAN AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8260
Mailing Address - Country:US
Mailing Address - Phone:505-532-9755
Mailing Address - Fax:505-532-8881
Practice Address - Street 1:4351 E LOHMAN AVE STE 200
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8260
Practice Address - Country:US
Practice Address - Phone:505-532-9755
Practice Address - Fax:505-532-8881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty