NPIMap

Organization Active NPI

Petroglyph Pathology Services LLC

  • Anatomic Pathology & Clinical Pathology Physician
  • Rio Rancho, NM
National Provider Identifier
1033501747
Registry record updated Apr 18, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Anatomic Pathology & Clinical Pathology PhysicianTaxonomy code 207ZP0102X
License
2002-0204 Issued in NM
Legal business name
PETROGLYPH PATHOLOGY SERVICES LLC
Practice address
640 Quantum Rd NE
Rio Rancho, NM 87124-4506
Phone
(505) 924-0209
NPI assigned
Mar 4, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 18, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
David Rowe
Title
Lab Manager
Phone
(505) 924-0209

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Anatomic Pathology & Clinical Pathology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 207ZP0102X 2002-0204 NM Primary

Addresses

Primary practice location

640 Quantum Rd NE
Rio Rancho, NM 87124-4506

Mailing address

640 Quantum Rd NE
Rio Rancho, NM 87124-4506
Phone (505) 924-0209

National Provider Directory

National Provider Directory

Locations

4619 Greene St NW
Ste A
Albuquerque, NM 87114
Phone (505) 924-0209

1207 Golf Course Rd SE
Ste B
Rio Rancho, NM 87124
Phone (505) 924-0209

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425427200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1524009600000",
    "number": "1033501747",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "640 QUANTUM RD NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871244506",
            "telephone_number": "505-924-0209"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "640 QUANTUM RD NE",
            "city": "RIO RANCHO",
            "state": "NM",
            "postal_code": "871244506",
            "telephone_number": "505-924-0209"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PETROGLYPH PATHOLOGY SERVICES LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-04",
        "last_updated": "2018-04-18",
        "status": "A",
        "authorized_official_last_name": "ROWE",
        "authorized_official_first_name": "DAVID",
        "authorized_official_title_or_position": "LAB MANAGER",
        "authorized_official_telephone_number": "505-924-0209"
    },
    "taxonomies": [
        {
            "code": "207ZP0102X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pathology, Anatomic Pathology & Clinical Pathology",
            "state": "NM",
            "license": "2002-0204",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rio Rancho, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 18, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.