Healthcare Provider Details

I. General information

NPI: 1831109560
Provider Name (Legal Business Name): NEW MEXICO ORTHOPAEDIC SURGERY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 09/13/2024
Certification Date: 09/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

IV. Provider business mailing address

8300 CONSTITUTION AVE NE
ALBUQUERQUE NM
87110-7613
US

V. Phone/Fax

Practice location:
  • Phone: 505-291-2300
  • Fax: 505-291-2299
Mailing address:
  • Phone: 505-357-3072
  • Fax: 505-213-0583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number3002
License Number StateNM

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269