Healthcare Provider Details

I. General information

NPI: 1861728016
Provider Name (Legal Business Name): NEW MEXICO PAIN AND SPINE INSTITUTE, A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/22/2009
Last Update Date: 09/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

125 LAGUNA BLVD SW
ALBUQUERQUE NM
87104-1157
US

V. Phone/Fax

Practice location:
  • Phone: 425-407-1000
  • Fax: 505-317-3676
Mailing address:
  • Phone: 425-407-1000
  • Fax: 505-317-3676

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberPT0103628
License Number StateNM

VIII. Authorized Official

Name: SARAH MUELLER
Title or Position: PRACTICE SUPPORT MANAGER
Credential:
Phone: 425-407-1000