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1255373676

NPI Code Detail

MEDICARE: EYE SURGERY CENTERS OF NEW MEXICO, LLC

MEDICARE: EYE SURGERY CENTERS OF NEW MEXICO, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA1903X	Ambulatory Surgical Clinic/Center	3076	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	490005504	OTHER	NM	RRB MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM00SS85	OTHER	NM	BCBSNM
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255373676
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EYE SURGERY CENTERS OF NEW MEXICO, LLC

Provider Business Mailing Address
First Line	:	PO BOX 90550
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87199-0550
Country	:	US
Telephone Number	:	505-768-1333
Fax Number	:	505-244-9566

Provider Business Practice Location Address
First Line	:	2947 RODEO PARK DR E
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-6303
Country	:	US
Telephone Number	:	505-474-9880
Fax Number	:	505-474-9881

Authorized Official
Title or Position	:	CFO
Name	:	MRS. JANICE E. YOUNG
Credential	:
Telephone Number	:	505-246-2622

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/10/2014

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Practice Location Address:

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Directions to “EYE SURGERY CENTERS OF NEW MEXICO, LLC ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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