MEDICARE: PURE INFUSION OF NEW MEXICO 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
1	261QI0500X	Infusion Therapy Clinic/Center
2	261QM1300X	Multi-Specialty Clinic/Center

General Provider Information

NPI Number	:	1982559803
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PURE INFUSION OF NEW MEXICO LLC

Provider Business Mailing Address
First Line	:	75 W TOWNE RIDGE PKWY STE 500
Second Line	:
City	:	SANDY
State	:	UT
Zip	:	84070-5531
Country	:	US
Telephone Number	:	801-590-9267
Fax Number	:

Provider Business Practice Location Address
First Line	:	1648B ALAMEDA BLVD NW
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-8807
Country	:	US
Telephone Number	:	505-966-9644
Fax Number	:

Authorized Official
Title or Position	:	VP OF PAYER DEVELOPMENT
Name	:	RACHEL FRAGA
Credential	:
Telephone Number	:	801-590-9267

Provider Enumeration Date	:	03/04/2026
Last Update Date	:	03/04/2026

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