Healthcare Provider Details

I. General information

NPI: 1891183943
Provider Name (Legal Business Name): NEW MEXICO ANESTHESIA ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/23/2014
Last Update Date: 01/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 SAINT MICHAELS DR
SANTA FE NM
87505-7601
US

IV. Provider business mailing address

490A W ZIA RD SUITE 280
SANTA FE NM
87505-6996
US

V. Phone/Fax

Practice location:
  • Phone: 505-988-1232
  • Fax: 505-913-5210
Mailing address:
  • Phone: 702-738-4546
  • Fax: 505-913-5210

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: JASON M ADAMS
Title or Position: CEO
Credential:
Phone: 702-738-4546