MEDICARE: ELIZABETH KIRCHER-RAITT

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	246ZS0410X	Surgical Technologist	00F449	NM

General Provider Information

NPI Number	:	1700951803
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH KIRCHER-RAITT

Provider Business Mailing Address
First Line	:	3167 SAN MATEO BLVD NE
Second Line	:	SUITE #305
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1921
Country	:	US
Telephone Number	:	505-286-0654
Fax Number	:	505-281-3022

Provider Business Practice Location Address
First Line	:	3167 SAN MATEO BLVD NE
Second Line	:	SUITE #305
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-1921
Country	:	US
Telephone Number	:	505-286-0654
Fax Number	:	505-281-3022

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/22/2006
Last Update Date	:	09/10/2014

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