Provider Demographics
NPI:1427104157
Name:INTERVENTIONAL PAIN SPECIALISTS OF NEW MEXICO, P.A.
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS OF NEW MEXICO, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:F
Authorized Official - Last Name:PACE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-898-1595
Mailing Address - Street 1:4824 MCMAHON BLVD NW
Mailing Address - Street 2:SUITE 119
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87114-5412
Mailing Address - Country:US
Mailing Address - Phone:505-898-1595
Mailing Address - Fax:
Practice Address - Street 1:4824 MCMAHON BLVD NW
Practice Address - Street 2:SUITE 119
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-5412
Practice Address - Country:US
Practice Address - Phone:505-898-1595
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2000-259208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009L89OtherBLUE CROSS BLUE SHIELD
NM61727369Medicaid
NM61727369Medicaid