MEDICARE: NEW MEXICO VEIN TREATMENT CENTER 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	208600000X	Surgery Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DD6448	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1336182021
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW MEXICO VEIN TREATMENT CENTER LLC

Provider Business Mailing Address
First Line	:	141 N ROADRUNNER PKWY STE 137
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2001
Country	:	US
Telephone Number	:	575-522-1974
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 N ROADRUNNER PKWY STE 137
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-2001
Country	:	US
Telephone Number	:	575-522-1974
Fax Number	:	575-522-5209

Authorized Official
Title or Position	:	MD/OWNER
Name	:	KHALID Y. KHAN
Credential	:
Telephone Number	:	575-522-1974

Provider Enumeration Date	:	06/13/2006
Last Update Date	:	06/07/2022

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