Healthcare Provider Details

I. General information

NPI: 1760840615
Provider Name (Legal Business Name): KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2016
Last Update Date: 12/09/2024
Certification Date: 12/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 E AMADOR AVE STE A
LAS CRUCES NM
88001-3660
US

IV. Provider business mailing address

3107 MOONLIGHT RIDGE ARC
LAS CRUCES NM
88011-1639
US

V. Phone/Fax

Practice location:
  • Phone: 575-288-2131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License NumberMD2014-0631
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NDUKA-OBI FRANCIS OSSAI
Title or Position: OWNER
Credential: MD
Phone: 520-270-7348