Healthcare Provider Details

I. General information

NPI: 1124067525
Provider Name (Legal Business Name): SURGERY CENTER OF ALBUQUERQUE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 03/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4333 PAN AMERICAN FWY NE SUITE B
ALBUQUERQUE NM
87107-6831
US

IV. Provider business mailing address

4333 PAN AMERICAN FWY NE SUITE B
ALBUQUERQUE NM
87107-6831
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-1073
  • Fax: 505-247-2153
Mailing address:
  • Phone: 505-247-1073
  • Fax: 505-247-2153

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3081
License Number StateNM

VIII. Authorized Official

Name: ALFRED A LOVATO JR.
Title or Position: OWNER
Credential: MD
Phone: 505-247-1073