Healthcare Provider Details

I. General information

NPI: 1073501508
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF NORTHERN NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 12/06/2022
Certification Date: 12/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 WEST RD SUITE A
LOS ALAMOS NM
87544-2275
US

IV. Provider business mailing address

3917 WEST RD SUITE A
LOS ALAMOS NM
87544-2275
US

V. Phone/Fax

Practice location:
  • Phone: 505-661-8900
  • Fax: 505-661-8961
Mailing address:
  • Phone: 505-661-8900
  • Fax: 505-661-8961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ANN CAROLYN LINNEBUR
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-661-8900