Provider Demographics
NPI:1386970341
Name:NEUROINTENSIVISTS OF NEW MEXICO, LLC
Entity type:Organization
Organization Name:NEUROINTENSIVISTS OF NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:MCCRANEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-750-0403
Mailing Address - Street 1:12231 ACADEMY RD NE
Mailing Address - Street 2:UNIT 301-268
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-7236
Mailing Address - Country:US
Mailing Address - Phone:505-750-0403
Mailing Address - Fax:888-505-3789
Practice Address - Street 1:2425 SAN PEDRO DR NE
Practice Address - Street 2:SUITE J
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4077
Practice Address - Country:US
Practice Address - Phone:505-750-0403
Practice Address - Fax:888-505-3789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1133103G00000X
NMMD2005-08332084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty