MEDICARE: MODERN PAIN & SPINE PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	2083P0901X	Public Health & General Preventive Medicine Physician
2	2083X0100X	Occupational Medicine Physician
3	2084N0400X	Neurology Physician
4	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1821695081
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MODERN PAIN & SPINE PC

Provider Business Mailing Address
First Line	:	1540 JUAN TABO BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-4460
Country	:	US
Telephone Number	:	595-519-8511
Fax Number	:

Provider Business Practice Location Address
First Line	:	1540 JUAN TABO BLVD NE STE A
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-4460
Country	:	US
Telephone Number	:	505-529-8511
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. ATHANASIOS KOSTANDINOS MANOLE
Credential	:	MD
Telephone Number	:	505-529-8511

Provider Enumeration Date	:	10/01/2020
Last Update Date	:	03/20/2026

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Directions to “MODERN PAIN & SPINE PC ” Practice Location

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