MEDICARE: NEW MEXICO HEALTH CONNECTIONS

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	302R00000X	Health Maintenance Organization		NM

General Provider Information

NPI Number	:	1922426006
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO HEALTH CONNECTIONS

Provider Business Mailing Address
First Line	:	2440 LOUISIANA BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4383
Country	:	US
Telephone Number	:	505-633-8020
Fax Number	:	866-231-1344

Provider Business Practice Location Address
First Line	:	2440 LOUISIANA BLVD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-4383
Country	:	US
Telephone Number	:	505-633-8020
Fax Number	:	866-231-1344

Authorized Official
Title or Position	:	CHEIF EXECUTIVE OFFICER
Name	:	MARTIN HICHEY
Credential	:	M.D.
Telephone Number	:	505-633-8057

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	04/04/2014

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Directions to “NEW MEXICO HEALTH CONNECTIONS ” Practice Location

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