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General NPI Number Information
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NPI Number | 1700949088
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Entity Type | Organization
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Legal Business Name | STATE OF NEW MEXICO DEPT. OF FINANCE AND ADMINISTRATIVE CENT PAYROLL
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Dates
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Enumeration Date | 12/18/2006
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 7905 MARBLE AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7886
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Country | US
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Telephone | 505-232-5726
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Fax | 505-232-5724
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Provider Business Mailing Address
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Address Line | 7905 MARBLE AVE NE
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City | ALBUQUERQUE
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State | NM
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Zip | 87110-7886
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Country | US
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Telephone | 505-232-5726
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Fax | 505-232-5724
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Authorized Official
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Title or Position | DEPUTY DIRECTOR, DOH
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Name | JENNIFER KAY THORNE-LEHMAN
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Credential |
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Telephone | 505-827-2503
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number | 03-069100-00-1
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License Number State | NM
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