Provider Demographics
NPI:1124703525
Name:NITOVO HEALTHCARE LLC
Entity type:Organization
Organization Name:NITOVO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SURESH
Authorized Official - Middle Name:
Authorized Official - Last Name:NEELAGARU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-506-9638
Mailing Address - Street 1:2500 US HIGHWAY 84
Mailing Address - Street 2:
Mailing Address - City:CHAMA
Mailing Address - State:NM
Mailing Address - Zip Code:87520-0784
Mailing Address - Country:US
Mailing Address - Phone:505-305-7766
Mailing Address - Fax:505-305-7066
Practice Address - Street 1:2500 US HIGHWAY 84
Practice Address - Street 2:
Practice Address - City:CHAMA
Practice Address - State:NM
Practice Address - Zip Code:87520-0784
Practice Address - Country:US
Practice Address - Phone:505-305-7766
Practice Address - Fax:505-305-7066
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-21
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty