Provider Demographics
NPI:1881909554
Name:STATESERV MEDICAL OF NEW MEXICO LLC
Entity type:Organization
Organization Name:STATESERV MEDICAL OF NEW MEXICO LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:ROODE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-633-7250
Mailing Address - Street 1:1201 S. ALMA SCHOOL ROAD
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85210
Mailing Address - Country:US
Mailing Address - Phone:505-884-2273
Mailing Address - Fax:866-280-0415
Practice Address - Street 1:3700 OSUNA RD NE
Practice Address - Street 2:SUITE 615
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4492
Practice Address - Country:US
Practice Address - Phone:505-884-2273
Practice Address - Fax:866-280-0415
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE STATESERV COMPANIES LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-18
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM5619060005Medicare NSC
AZ5619060001Medicare NSC