Provider Demographics
NPI:1316133580
Name:S. RAMASAMY, M.D., LLC
Entity type:Organization
Organization Name:S. RAMASAMY, M.D., LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SENTHILKUMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMASAMY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-234-1616
Mailing Address - Street 1:1101 GOLF COURSE RD SE
Mailing Address - Street 2:SUITE 203
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-4728
Mailing Address - Country:US
Mailing Address - Phone:505-234-1616
Mailing Address - Fax:505-234-1617
Practice Address - Street 1:1101 GOLF COURSE RD SE
Practice Address - Street 2:SUITE 203
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-4728
Practice Address - Country:US
Practice Address - Phone:505-234-1616
Practice Address - Fax:505-234-1617
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-20
Last Update Date:2020-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2003-05522084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1326056201OtherNPI
NM01723049Medicaid
NM1316133580OtherNPI
NM43027261Medicaid
NM341400606Medicare PIN
NMH52343Medicare UPIN
NM100521027Medicare PIN