Healthcare Provider Details

I. General information

NPI: 1205878758
Provider Name (Legal Business Name): ALBUQUERQUE AMBULATORY EYE SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 HARPER DR NE
ALBUQUERQUE NM
87109-3587
US

IV. Provider business mailing address

PO BOX 90550
ALBUQUERQUE NM
87199-0550
US

V. Phone/Fax

Practice location:
  • Phone: 505-823-8545
  • Fax: 505-823-8549
Mailing address:
  • Phone: 505-768-1333
  • Fax: 505-244-9566

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3087
License Number StateNM

VIII. Authorized Official

Name: MRS. JANICE E. YOUNG
Title or Position: CFO
Credential:
Phone: 505-246-2622