Provider Demographics
NPI:1962972943
Name:ALBUQUERQUE NEPHROLOGY ASSOCIATES
Entity type:Organization
Organization Name:ALBUQUERQUE NEPHROLOGY ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:J
Authorized Official - Last Name:MONTANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-600-2513
Mailing Address - Street 1:4343 PAN AMERICAN FREEWAY NE SUITE 236
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87107
Mailing Address - Country:US
Mailing Address - Phone:505-600-2511
Mailing Address - Fax:
Practice Address - Street 1:4343 PAN AMERICAN FREEWAY NE
Practice Address - Street 2:SUITE 236
Practice Address - City:ALBUQEURQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-6833
Practice Address - Country:US
Practice Address - Phone:505-600-2511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-03
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM001Medicaid