# OPTUMCARE ENDOSCOPY CENTER NEW MEXICO, LLC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Parent organization:** DAVITA MEDICAL GROUP NEW MEXICO, LLC
- **Other names:** DaVita Medical Endoscopy
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1962685834
- **Legal business name:** DAVITA MEDICAL GROUP NEW MEXICO, LLC
- **Authorized official:** JOHN G LIETHEN (SECRETARY)
- **Authorized official phone:** (952) 205-6262

## Contact information

- **Practice address:** 5400 GIBSON BLVD SE, FLOOR 2; ELEVATOR C, ALBUQUERQUE, NM 87108-4729
- **Practice address phone:** (505) 262-7174
- **Practice address fax:** (505) 262-3562
- **Mailing address:** PO BOX 912680, DENVER, CO 80291-4729
- **Mailing address phone:** (505) 262-7000
- **Mailing address fax:** (505) 262-7652

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | PENDING | NM | Yes |

## Other

- **Enumeration date:** 12/13/2007
- **Last updated:** 02/12/2020