Healthcare Provider Details

I. General information

NPI: 1952697922
Provider Name (Legal Business Name): NEW MEXICO ORTHOPAEDIC ASSOCIATES PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2011
Last Update Date: 07/21/2023
Certification Date: 07/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 RIO RANCHO BLVD SE SUITE E
RIO RANCHO NM
87124
US

IV. Provider business mailing address

2100 LOUISIANA BLVD NE STE 410
ALBUQUERQUE NM
87110-5412
US

V. Phone/Fax

Practice location:
  • Phone: 505-892-3520
  • Fax: 505-892-3521
Mailing address:
  • Phone: 505-724-4384
  • Fax: 505-724-4384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: JEFFREY W RACCA
Title or Position: PRESIDENT
Credential: MD
Phone: 505-724-4300