Organization
DAVITA MEDICAL GROUP NEW MEXICO, LLC
Active
Parent organization
DAVITA MEDICAL GROUP NEW MEXICO, LLC
Other names
DaVita Medical Group
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA MEDICAL GROUP NEW MEXICO, LLC
Authorized official
VIJAY KOTTE (TREASURER)
(303) 876-6457
Entity
Organization
Contact information
Practice address
5150 JOURNAL CENTER BLVD NE FL 2, ALBUQUERQUE, NM 87109-5900
(505) 232-1530
Mailing address
PO BOX 26028, ALBUQUERQUE, NM 87125-6028
(505) 262-3135
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Enumeration date
09/14/2018
Last updated
09/14/2018
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