Provider Demographics
NPI:1386604304
Name:NORTHERN NEW MEXICO UROLOGY LLC
Entity type:Organization
Organization Name:NORTHERN NEW MEXICO UROLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AKHIL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:DAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-661-8500
Mailing Address - Street 1:3917 WEST RD
Mailing Address - Street 2:SUITE 137
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2275
Mailing Address - Country:US
Mailing Address - Phone:505-661-8500
Mailing Address - Fax:505-661-0096
Practice Address - Street 1:3917 WEST RD
Practice Address - Street 2:SUITE 137
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-2275
Practice Address - Country:US
Practice Address - Phone:505-661-8500
Practice Address - Fax:505-661-0096
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-173174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB9141Medicaid
NMNM009J59OtherBCBS
NMG81450Medicare UPIN