Provider Demographics
NPI:1639145808
Name:ALBUQUERQUE CENTER FOR RHEUMATOLOGY PC
Entity type:Organization
Organization Name:ALBUQUERQUE CENTER FOR RHEUMATOLOGY PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LEROY
Authorized Official - Middle Name:ARNOLD
Authorized Official - Last Name:PACHECO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-341-4148
Mailing Address - Street 1:1617 UNIVERSITY BLVD NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-1710
Mailing Address - Country:US
Mailing Address - Phone:505-341-4148
Mailing Address - Fax:505-345-9914
Practice Address - Street 1:1617 UNIVERSITY BLVD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-1710
Practice Address - Country:US
Practice Address - Phone:505-341-4148
Practice Address - Fax:505-345-9914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-116208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM12375Medicaid
522944752MOtherMEDICARE
NM12375Medicaid