MEDICARE: AMIGO CASE MANAGEMENT, INC.

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	251B00000X	Case Management Agency		NM

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932265477
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMIGO CASE MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	2610 SAN MATEO BLVD NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3162
Country	:	US
Telephone Number	:	505-362-2236
Fax Number	:

Provider Business Practice Location Address
First Line	:	2610 SAN MATEO BLVD NE STE B
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-3162
Country	:	US
Telephone Number	:	505-362-2236
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. ANTHONY L. ROSS
Credential	:
Telephone Number	:	505-362-2236

Provider Enumeration Date	:	12/29/2006
Last Update Date	:	08/22/2020

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