Healthcare Provider Details

I. General information

NPI: 1326570599
Provider Name (Legal Business Name): NEW MEXICO FOOT AND ANKLE INSTITUTE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2017
Last Update Date: 05/30/2023
Certification Date: 05/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10511 GOLF COURSE RD NW STE 203
ALBUQUERQUE NM
87114-5917
US

IV. Provider business mailing address

4343 PAN AMERICAN FWY NE STE 234
ALBUQUERQUE NM
87107-6834
US

V. Phone/Fax

Practice location:
  • Phone: 505-872-3333
  • Fax: 505-880-1002
Mailing address:
  • Phone: 505-880-1000
  • Fax: 505-880-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: NATHAN D IVEY
Title or Position: OWNER
Credential: DPM
Phone: 505-880-1000