Healthcare Provider Details

I. General information

NPI: 1225932445
Provider Name (Legal Business Name): EXTRAORDINARY SURGICAL ASSIST SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2026
Last Update Date: 10/03/2026
Certification Date: 10/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 HARPER DR NE
ALBUQUERQUE NM
87109-3573
US

IV. Provider business mailing address

5700 HARPER DR NE
ALBUQUERQUE NM
87109-3573
US

V. Phone/Fax

Practice location:
  • Phone: 505-843-7813
  • Fax:
Mailing address:
  • Phone: 505-843-7813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZS0410X
TaxonomySurgical Technologist
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. ALEXANDRA TAYLOR
Title or Position: HUMAN RESOURCES DIRECTOR
Credential:
Phone: 575-221-0137