Organization
HIGHLANDS SURGICAL SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SITARAMAKRISHNA KOTHALANKA MD (OWNER)
(505) 374-2521
Entity
Organization
Contact information
Practice address
315 N 3RD AVE, CLAYTON, NM 88415-3300
(505) 374-2521
(505) 374-2498
Mailing address
315 N 3RD AVE, CLAYTON, NM 88415-3300
(505) 374-2521
(505) 374-2498
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD2007-0129
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1184644080
INDIVIDUAL NPI
—
05
—
32537034
—
NM
Enumeration date
09/06/2007
Last updated
11/01/2007
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