Provider Demographics
NPI:1386999365
Name:NEW MEXICO FOOT AND ANKLE CENTERS LLC
Entity type:Organization
Organization Name:NEW MEXICO FOOT AND ANKLE CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WREGE
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:505-271-9900
Mailing Address - Street 1:5111 JUAN TABO BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-2672
Mailing Address - Country:US
Mailing Address - Phone:505-271-9900
Mailing Address - Fax:505-271-0217
Practice Address - Street 1:5111 JUAN TABO BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-2672
Practice Address - Country:US
Practice Address - Phone:505-271-9900
Practice Address - Fax:505-271-0217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Multi-Specialty