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NPI Code Detail

MEDICARE: STATE OF NEW MEXICO

MEDICARE: STATE OF NEW MEXICO
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
12084P0800XPsychiatry Physician76-135NM

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 : 1912918103
Entity Type Code : Organization
Provider Name (Legal Business Name) : STATE OF NEW MEXICO
Provider Business Mailing Address
First Line : 3695 HOT SPRINGS BLVD
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-9549
Country : US
Telephone Number : 505-454-2100
Fax Number : 505-454-2130
Provider Business Practice Location Address
First Line : 700 FRIEDMAN AVE
Second Line :
City : LAS VEGAS
State : NM
Zip : 87701-4231
Country : US
Telephone Number : 505-454-5100
Fax Number : 505-454-0397
Authorized Official
Title or Position : INTERIM HOSPITAL ADMINISTRATOR
Name : MR. STEVE MARTINEZ
Credential :
Telephone Number : 505-454-2100
Provider Enumeration Date : 08/11/2006
Last Update Date : 08/22/2020

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Directions to “STATE OF NEW MEXICO ” Practice Location

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