Organization
OPTUMCARE ENDOSCOPY CENTER NEW MEXICO, LLC
Active
Parent organization
DAVITA MEDICAL GROUP NEW MEXICO, LLC
Other names
DaVita Medical Endoscopy
Organization subpart
Yes
Provider details
NPI number
Legal business name
DAVITA MEDICAL GROUP NEW MEXICO, LLC
Authorized official
JOHN G LIETHEN (SECRETARY)
(952) 205-6262
Entity
Organization
Contact information
Practice address
5400 GIBSON BLVD SE, FLOOR 2; ELEVATOR C, ALBUQUERQUE, NM 87108-4729
(505) 262-7174
(505) 262-3562
Mailing address
PO BOX 912680, DENVER, CO 80291-4729
(505) 262-7000
(505) 262-7652
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
PENDING
NM
Other
Enumeration date
12/13/2007
Last updated
02/12/2020
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