Provider Demographics
NPI:1912900754
Name:ANESTHESIA ASSOCIATES OF NEW MEXICO P C
Entity type:Organization
Organization Name:ANESTHESIA ASSOCIATES OF NEW MEXICO P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KISHORE
Authorized Official - Middle Name:B
Authorized Official - Last Name:MANNE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-260-4300
Mailing Address - Street 1:1720 LOUISIANA BLVD NE
Mailing Address - Street 2:STE 401
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7020
Mailing Address - Country:US
Mailing Address - Phone:505-260-4300
Mailing Address - Fax:505-260-4338
Practice Address - Street 1:1100 CENTRAL AVE SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4930
Practice Address - Country:US
Practice Address - Phone:505-841-1234
Practice Address - Fax:505-841-1956
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-24
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPT0002685174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0747917Medicaid
CO94001930Medicaid
NM002Medicaid
NM51227Medicaid
NMW19969Medicare UPIN
NM2370510Medicare ID - Type UnspecifiedMEDICARE
NM51227Medicaid