Organization Name: | NEW MEXICO PAIN MANAGEMENT, LLC |
NPI Number: | 1215173000 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JONAS R. SKARDIS (OWNER) |
Mailing Address: | 460 Saint Michaels Dr Building 200 Santa Fe |
State: | NM US |
Postal Code: | 875057619 |
Phone Number: | 5059885551 |
Fax Number: | |
NPI Enumeration Date: | 12/28/2008 |
NPI Last Update Date: | 12/28/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | 192RX2 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | NM |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |