MEDICARE: SOUTHEAST NEW MEXICO PODIATRY ASSOCIATES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BC3200X	Customized Equipment (DME)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477111482
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTHEAST NEW MEXICO PODIATRY ASSOCIATES INC

Provider Business Mailing Address
First Line	:	1016 W PIERCE ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-4013
Country	:	US
Telephone Number	:	575-885-3445
Fax Number	:	575-887-0163

Provider Business Practice Location Address
First Line	:	5419 N LOVINGTON HWY STE 9
Second Line	:
City	:	HOBBS
State	:	NM
Zip	:	88240-9135
Country	:	US
Telephone Number	:	575-964-8770
Fax Number	:	575-887-0163

Authorized Official
Title or Position	:	PRACTICE MANAGER
Name	:	OLGA MAGEE
Credential	:
Telephone Number	:	575-885-3445

Provider Enumeration Date	:	06/04/2019
Last Update Date	:	11/04/2020

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