Healthcare Provider Details

I. General information

NPI: 1750356820
Provider Name (Legal Business Name): ORTHOPEDIC ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 E 30TH ST STE 101
FARMINGTON NM
87401-8990
US

IV. Provider business mailing address

2300 E 30TH ST BLDG D STE 101
FARMINGTON NM
87401-8990
US

V. Phone/Fax

Practice location:
  • Phone: 505-327-1400
  • Fax: 505-564-3202
Mailing address:
  • Phone: 505-327-1400
  • Fax: 505-564-3202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: BRENDA KAY COMPTON
Title or Position: BILLING MANAGER
Credential:
Phone: 505-327-1400