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General NPI Number Information
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NPI Number | 1760840615
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Entity Type | Organization
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Legal Business Name | KIDNEY DISEASE AND HYPERTENSION CENTER OF NEW MEXICO LLC
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Dates
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Enumeration Date | 02/08/2016
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 250 E AMADOR AVE STE A
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City | LAS CRUCES
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State | NM
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Zip | 88001-3660
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Country | US
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Telephone | 575-288-2131
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Fax |
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Provider Business Mailing Address
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Address Line | 3107 MOONLIGHT RIDGE ARC
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City | LAS CRUCES
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State | NM
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Zip | 88011-1639
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | NDUKA-OBI FRANCIS OSSAI
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Credential | MD
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Telephone | 520-270-7348
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD2014-0631
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License Number State | NM
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