Davita Medical Group New Mexico, LLC

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

Legal business name

DAVITA MEDICAL GROUP NEW MEXICO, LLC

Doing business as

DaVita Medical Group

Practice address

5150 Journal Center Blvd NE FL 2
Albuquerque, NM 87109-5900

Phone

(505) 232-1530

NPI assigned

Sep 14, 2018

Organization subpart

Yes

Parent organization

DAVITA MEDICAL GROUP NEW MEXICO, LLCAs reported in NPPES

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

Authorized official

Name

Vijay Kotte

Title

Treasurer

Phone

(303) 876-6457

Specialties & licenses 1

Addresses

Other names 1

• DaVita Medical Group Doing business as

Part of

Lovelace Healthcare Center-Santa Fe

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

• Optumcare Endoscopy Center New Mexico, LLC

  • Ambulatory Surgical Clinic/Center
  • Albuquerque, NM
  • NPI 1962685834

  Member Of

  NPD member

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

{
    "created_epoch": "1536883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1536883200000",
    "number": "1083197032",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 26028",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871256028",
            "telephone_number": "505-262-3135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 JOURNAL CENTER BLVD NE FL 2",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095900",
            "telephone_number": "505-232-1530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DAVITA MEDICAL GROUP NEW MEXICO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA MEDICAL GROUP NEW MEXICO, LLC",
        "enumeration_date": "2018-09-14",
        "last_updated": "2018-09-14",
        "status": "A",
        "authorized_official_last_name": "KOTTE",
        "authorized_official_first_name": "VIJAY",
        "authorized_official_title_or_position": "TREASURER",
        "authorized_official_telephone_number": "303-876-6457"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• William Austin Davis
• Zachary Davis
• Amanda S Davison, LMFT
• Ricky Lawrence Davison, D.D.S.
• Ronda Davison, RN
• Kristin Dawe, CCHW
• Leah Dawit
• Angie D. Dawson, LCSW
• Karen Elizabeth Dawson, DOM
• Paisley Dawson

• Durable Medical Equipment & Medical Supplies in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Durable Medical Equipment & Medical Supplies in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 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.