Provider Demographics
NPI:1891784088
Name:VASPRO INC
Entity type:Organization
Organization Name:VASPRO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:G
Authorized Official - Last Name:ABBOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-298-1558
Mailing Address - Street 1:10400 ACADEMY RD NE
Mailing Address - Street 2:SUITE 340
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87111-1229
Mailing Address - Country:US
Mailing Address - Phone:505-298-1558
Mailing Address - Fax:505-298-7012
Practice Address - Street 1:10400 ACADEMY RD NE
Practice Address - Street 2:SUITE 340
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87111-1229
Practice Address - Country:US
Practice Address - Phone:505-298-1558
Practice Address - Fax:505-298-7012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR25188363L00000X
NMR19106363L00000X
NMR31749363L00000X
GARN130480363L00000X
AZRN086525363L00000X
NMR18198363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM017025OtherBC/BS OF NM
NM18828779Medicaid
NM=========OtherCOMMERCIAL