MEDICARE: ANESTHESIA ASSOCIATES OF NEW MEXICO P C

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	PT0002685	NM

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

NPI Number	:	1912900754
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANESTHESIA ASSOCIATES OF NEW MEXICO P C

Provider Business Mailing Address
First Line	:	1720 LOUISIANA BLVD NE
Second Line	:	STE 401
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-7020
Country	:	US
Telephone Number	:	505-260-4300
Fax Number	:	505-260-4338

Provider Business Practice Location Address
First Line	:	1100 CENTRAL AVE SE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87106-4930
Country	:	US
Telephone Number	:	505-841-1234
Fax Number	:	505-841-1956

Authorized Official
Title or Position	:	PRESIDENT
Name	:	KISHORE B. MANNE
Credential	:	M.D.
Telephone Number	:	505-260-4300

Provider Enumeration Date	:	05/24/2005
Last Update Date	:	09/27/2007

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841