Provider Demographics
NPI:1700949088
Name:STATE OF NEW MEXICO DEPT. OF FINANCE AND ADMINISTRATIVE CENT PAYROLL
Entity type:Organization
Organization Name:STATE OF NEW MEXICO DEPT. OF FINANCE AND ADMINISTRATIVE CENT PAYROLL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DEPUTY DIRECTOR, DOH
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:THORNE-LEHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-827-2503
Mailing Address - Street 1:7905 MARBLE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7886
Mailing Address - Country:US
Mailing Address - Phone:505-232-5726
Mailing Address - Fax:505-232-5724
Practice Address - Street 1:7905 MARBLE AVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7886
Practice Address - Country:US
Practice Address - Phone:505-232-5726
Practice Address - Fax:505-232-5724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03-069100-00-1332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ2441Medicaid
4638090002Medicare PIN