Provider Demographics
NPI:1932964715
Name:SANDIA PAIN CENTER LLC
Entity Type:Organization
Organization Name:SANDIA PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CONSULTANT
Authorized Official - Prefix:
Authorized Official - First Name:RUSSELL
Authorized Official - Middle Name:
Authorized Official - Last Name:KNIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:PRACTICE CONSULTANT
Authorized Official - Phone:915-328-4793
Mailing Address - Street 1:8501 CANDELARIA RD NE STE H
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1034
Mailing Address - Country:US
Mailing Address - Phone:505-420-4971
Mailing Address - Fax:505-384-6594
Practice Address - Street 1:8501 CANDELARIA RD NE STE E
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1034
Practice Address - Country:US
Practice Address - Phone:505-420-4971
Practice Address - Fax:505-384-6594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-20
Last Update Date:2024-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty