Provider Demographics
NPI:1144364472
Name:PAIN MANAGEMENT CLINICS OF NEW MEXICO, INC.
Entity type:Organization
Organization Name:PAIN MANAGEMENT CLINICS OF NEW MEXICO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-248-0698
Mailing Address - Street 1:8005 PENNSYLVANIA CIR NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7810
Mailing Address - Country:US
Mailing Address - Phone:505-248-0698
Mailing Address - Fax:505-248-0798
Practice Address - Street 1:8005 PENNSYLVANIA CIR NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7810
Practice Address - Country:US
Practice Address - Phone:505-248-0698
Practice Address - Fax:505-248-0798
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-19
Last Update Date:2018-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-1464101YA0400X
NM4735225700000X
NM3659225700000X
NM94-300208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM21906Medicaid
NM201013423OtherPRESBYTERIAN HEALTH ID
NM00NM003410OtherBLUE SHIELD ID NUMBER
NM201013423OtherPRESBYTERIAN HEALTH ID
NM21906Medicaid
NM00NM003410OtherBLUE SHIELD ID NUMBER