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Organization
OPTUMCARE NEW MEXICO, LLC
Active
Organization
OPTUMCARE NEW MEXICO, LLC
Active
Other names
DaVita Medical Group
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN G LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
5150 JOURNAL CENTER BLVD NE, ALBUQUERQUE, NM 87109-5900
(505) 232-1500
(505) 232-1584
Mailing address
PO BOX 26028, ALBUQUERQUE, NM 87125-6028
(505) 232-1500
(505) 232-1584
Taxonomy
Speciality
Code
Description
License number
State
247100000X
Radiologic Technologist
Primary
—
—
2471B0102X
Bone Densitometry Radiologic Technologist
—
—
2471C3401X
Computed Tomography Radiologic Technologist
—
—
2471C3402X
Radiography Radiologic Technologist
—
—
2471M1202X
Magnetic Resonance Imaging Radiologic Technologist
—
—
2471M2300X
Mammography Radiologic Technologist
—
—
2471S1302X
Sonography Radiologic Technologist
—
—
2471V0105X
Vascular Sonography Radiologic Technologist
—
—
2471V0106X
Vascular-Interventional Technology Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
93670567
—
NM
Enumeration date
07/15/2008
Last updated
08/20/2019
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