NPIMap

Organization Active NPI

Optumcare New Mexico, LLC

Doing business as DaVita Medical Group

  • Eyewear Supplier
  • Albuquerque, NM
National Provider Identifier
1588947485
Registry record updated Aug 22, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Eyewear SupplierTaxonomy code 332H00000X
Legal business name
OPTUMCARE NEW MEXICO, LLC
Doing business as
DaVita Medical Group
Practice address
5150 Journal Center Blvd NE
Albuquerque, NM 87109-5900
Phone
(505) 262-3370
Fax
(505) 262-3226
NPI assigned
Sep 27, 2011
Last updated
Aug 22, 2019By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2019

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

Authorized official

Name
John G Liethen
Title
Secretary
Phone
(952) 205-6262

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Eyewear Supplier 332H00000X Primary

Addresses

Primary practice location

5150 Journal Center Blvd NE
Albuquerque, NM 87109-5900

Mailing address

PO Box 26028
Albuquerque, NM 87125-6028
Phone (505) 262-7960

Other names 1

  • DaVita Medical Group Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Lovelace Healthcare Center-Santa Fe24 organizations share this tax ID, including this one

Other organizations with this tax ID 23

Organizations that report the same tax identification number in the National Provider Directory.

View all 23

NPI Registry JSON

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

{
    "created_epoch": "1317081600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1566432000000",
    "number": "1588947485",
    "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": "505-262-7960"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5150 JOURNAL CENTER BLVD NE",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871095900",
            "telephone_number": "505-262-3370",
            "fax_number": "505-262-3226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE NEW MEXICO, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-27",
        "last_updated": "2019-08-22",
        "status": "A",
        "authorized_official_last_name": "LIETHEN",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "SECRETARY",
        "authorized_official_telephone_number": "952-205-6262"
    },
    "taxonomies": [
        {
            "code": "332H00000X",
            "taxonomy_group": "",
            "desc": "Eyewear Supplier",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Albuquerque, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2019; 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.