State of New Mexico

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

5087 Issued in NM

Legal business name

STATE OF NEW MEXICO

Practice address

992 S Broadway
Truth Or Consequences, NM 87901-3198

Phone

(575) 894-4200

Fax

(575) 894-4291

NPI assigned

Aug 1, 2006

Organization subpart

Yes

Parent organization

STATE OF NEW MEXICOAs reported in NPPES

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

Authorized official

Name

Marie R Richter

Title

Chief Financial Officer

Phone

(575) 894-4216

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• New Mexico State Veterans Home Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Scientific Laboratory Division Nmdoh

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270512000000",
    "number": "1073529624",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "992 S BROADWAY",
            "city": "TRUTH OR CONSEQUENCES",
            "state": "NM",
            "postal_code": "879013198",
            "telephone_number": "575-894-4200",
            "fax_number": "575-894-4291"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "992 S BROADWAY",
            "city": "TRUTH OR CONSEQUENCES",
            "state": "NM",
            "postal_code": "879013198",
            "telephone_number": "575-894-4200",
            "fax_number": "575-894-4291"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW MEXICO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "STATE OF NEW MEXICO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-04-06",
        "status": "A",
        "authorized_official_last_name": "RICHTER",
        "authorized_official_first_name": "MARIE",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "CHIEF FINANCIAL OFFICER",
        "authorized_official_telephone_number": "575-894-4216"
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NM",
            "license": "32D0693149",
            "primary": false
        },
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "NM",
            "license": "5087",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "52367",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "New Mexico State Veterans Home",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Tiffany M Smith
• Rod Sorrell, CNA
• McKensi An Inez Spears, BS, CSW
• Melanie Lu Spears, CSW
• State of New Mexico
• State of New Mexico
• State of New Mexico
• Deborah Ann Stubblefield, RCP
• Lynetta Irene Sullivan
• Leslie Summerlin, PHARMD

• Clinical Medical Laboratory in Truth Or Consequences, NM
• Providers in Truth Or Consequences, NM by specialty
• Clinical Medical Laboratory in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.