# OPTUMCARE NEW MEXICO, LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** DaVita Medical Group
- **Organization subpart:** No

## Provider details

- **NPI number:** 1245494723
- **Authorized official:** JOHN G LIETHEN (SECRETARY)
- **Authorized official phone:** (952) 205-6262

## Contact information

- **Practice address:** 5150 JOURNAL CENTER BLVD NE, ALBUQUERQUE, NM 87109-5900
- **Practice address phone:** (505) 232-1500
- **Practice address fax:** (505) 232-1584
- **Mailing address:** PO BOX 26028, ALBUQUERQUE, NM 87125-6028
- **Mailing address phone:** (505) 232-1500
- **Mailing address fax:** (505) 232-1584

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 247100000X | Radiologic Technologist | — | — | Yes |
| 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

- **Enumeration date:** 07/15/2008
- **Last updated:** 08/20/2019

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 93670567 | — | NM |