Provider Demographics
NPI:1174911093
Name:NEW MEXICO CENTER FOR MINIMALLY INVASIVE THERAPIES
Entity type:Organization
Organization Name:NEW MEXICO CENTER FOR MINIMALLY INVASIVE THERAPIES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO MEDICAL DIRECTOR PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SANDEEP
Authorized Official - Middle Name:
Authorized Official - Last Name:RAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-302-3561
Mailing Address - Street 1:4901 LANG AVE NE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4495
Mailing Address - Country:US
Mailing Address - Phone:505-227-9737
Mailing Address - Fax:505-200-3808
Practice Address - Street 1:4901 LANG AVE NE
Practice Address - Street 2:SUITE 202
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-4495
Practice Address - Country:US
Practice Address - Phone:505-227-9737
Practice Address - Fax:505-200-3808
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-30
Last Update Date:2016-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2014-08232085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Single Specialty