Basic Information
| Provider Information | |||||||||
| NPI: | 1932441300 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACUTE CARE SURGERY MEDICAL GROUP OF NEW MEXICO, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 555 CAPITOL MALL | ||||||||
| Address2: | SUITE 260 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958144504 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9164410400 | ||||||||
| FaxNumber: | 9164410406 | ||||||||
| Practice Location | |||||||||
| Address1: | 601 DR MARTIN LUTHER KING JR AVE NE | ||||||||
| Address2: | |||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871023619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5057278000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2013 | ||||||||
| LastUpdateDate: | 03/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | LEON | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 9164410400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0127X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.