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NPI Code Detail

MEDICARE: ALBUQUERQUE MINIMALLY INVASIVE UROLOGY LLC

MEDICARE: ALBUQUERQUE MINIMALLY INVASIVE UROLOGY LLC
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
1208800000XUrology PhysicianG3848TX

Other Identifiers

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

General Provider Information

NPI Number : 1710122775
Entity Type Code : Organization
Provider Name (Legal Business Name) : ALBUQUERQUE MINIMALLY INVASIVE UROLOGY LLC
Provider Business Mailing Address
First Line : 1700 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-3504
Country : US
Telephone Number : 915-351-6020
Fax Number : 915-351-6048
Provider Business Practice Location Address
First Line : 1700 N MESA ST
Second Line :
City : EL PASO
State : TX
Zip : 79902-3504
Country : US
Telephone Number : 915-351-6020
Fax Number : 915-351-6048
Authorized Official
Title or Position : OWNER
Name : MARK D THOMAS
Credential : MD
Telephone Number : 915-351-6020
Provider Enumeration Date : 12/04/2008
Last Update Date : 10/03/2014

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