Healthcare Provider Details

I. General information

NPI: 1144364472
Provider Name (Legal Business Name): PAIN MANAGEMENT CLINICS OF NEW MEXICO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 06/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8005 PENNSYLVANIA CIR NE
ALBUQUERQUE NM
87110-7810
US

IV. Provider business mailing address

8005 PENNSYLVANIA CIR NE
ALBUQUERQUE NM
87110-7810
US

V. Phone/Fax

Practice location:
  • Phone: 505-248-0698
  • Fax: 505-248-0798
Mailing address:
  • Phone: 505-248-0698
  • Fax: 505-248-0798

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberI-1464
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number4735
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number3659
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number94-300
License Number StateNM

VIII. Authorized Official

Name: DR. JOAN P LEWIS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-248-0698