Healthcare Provider Details

I. General information

NPI: 1467682237
Provider Name (Legal Business Name): NEW MEXICO VA HEALTHCARE SYSTEM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2009
Last Update Date: 07/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 SAN PEDRO DR SE AMBULATORY CARE (115)
ALBUQUERQUE NM
87108-5153
US

IV. Provider business mailing address

1111 CARDENAS DR SE APT 313
ALBUQUERQUE NM
87108-4736
US

V. Phone/Fax

Practice location:
  • Phone: 505-265-1711
  • Fax: 505-256-2888
Mailing address:
  • Phone: 575-313-0916
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QV0200X
TaxonomyVA Clinic/Center
License NumberR27976
License Number StateNM

VIII. Authorized Official

Name: DR. MARTIN SCHIMMEL
Title or Position: CHIEF OF AMBULATORY CARE
Credential: M.D.
Phone: 505-265-1711