Provider Demographics
NPI:1124067525
Name:SURGERY CENTER OF ALBUQUERQUE, LLC
Entity type:Organization
Organization Name:SURGERY CENTER OF ALBUQUERQUE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ALFRED
Authorized Official - Middle Name:A
Authorized Official - Last Name:LOVATO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:505-247-1073
Mailing Address - Street 1:4333 PAN AMERICAN FWY NE
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107-6831
Mailing Address - Country:US
Mailing Address - Phone:505-247-1073
Mailing Address - Fax:505-247-2153
Practice Address - Street 1:4333 PAN AMERICAN FWY NE
Practice Address - Street 2:SUITE B
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6831
Practice Address - Country:US
Practice Address - Phone:505-247-1073
Practice Address - Fax:505-247-2153
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-05
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3081261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical