Healthcare Provider Details

I. General information

NPI: 1508574724
Provider Name (Legal Business Name): NEW MEXICO VASCULAR CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 NM HIGHWAY 564
GALLUP NM
87301-4873
US

IV. Provider business mailing address

9192 W UNION HILLS DR
PEORIA AZ
85382-8208
US

V. Phone/Fax

Practice location:
  • Phone: 505-542-0090
  • Fax: 520-542-0155
Mailing address:
  • Phone: 602-374-4101
  • Fax: 602-441-0522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID NYE
Title or Position: OWNER
Credential: DO
Phone: 480-363-7778