Healthcare Provider Details

I. General information

NPI: 1922943224
Provider Name (Legal Business Name): MODERN SURGICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/22/2026
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2500 LOUISIANA BLVD NE STE 600
ALBUQUERQUE NM
87110-4372
US

IV. Provider business mailing address

1540 JUAN TABO BLVD NE STE A
ALBUQUERQUE NM
87112-4460
US

V. Phone/Fax

Practice location:
  • Phone: 505-319-0231
  • Fax:
Mailing address:
  • Phone: 505-800-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. ATHANASIOS MANOLE
Title or Position: OWNER
Credential:
Phone: 505-319-0231