NPIMap

Organization Active NPI

State of New Mexico

  • Psychiatry Physician
  • Las Vegas, NM
National Provider Identifier
1912918103
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatry PhysicianTaxonomy code 2084P0800X
License
76-135 Issued in NM
Legal business name
STATE OF NEW MEXICO
Practice address
700 Friedman Ave
Las Vegas, NM 87701-4231
Phone
(505) 454-5100
Fax
(505) 454-0397
NPI assigned
Aug 11, 2006
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mr. Steve Martinez
Title
Interim Hospital Administrator
Phone
(505) 454-2100

Corporate family (same tax ID) 9

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

National Provider Directory

National Provider Directory
Tax ID family
San Miguel Mora Communi (10 organizations share this tax ID)

Specialties & licenses 1

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatry PhysicianGroup: 193400000X MULTIPLE SINGLE SPECIALTY GROUP 2084P0800X 76-135 NM Primary

Addresses

NPPES NPI Registry

Primary practice location

700 Friedman Ave
Las Vegas, NM 87701-4231

Mailing address

3695 Hot Springs Blvd
Las Vegas, NM 87701-9549
Phone (505) 454-2100

Other identifiers 1

NPPES NPI Registry
IdentifierTypeStateIssuer
03038MedicaidNM

Other names 1

NPPES NPI Registry
  • NM Behavioral Health Institute @ Las Vegas Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Aug 22, 2020.

{
    "created_epoch": "1155254400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1912918103",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3695 HOT SPRINGS BLVD",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877019549",
            "telephone_number": "505-454-2100",
            "fax_number": "505-454-2130"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "700 FRIEDMAN AVE",
            "city": "LAS VEGAS",
            "state": "NM",
            "postal_code": "877014231",
            "telephone_number": "505-454-5100",
            "fax_number": "505-454-0397"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STATE OF NEW MEXICO",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-11",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "MARTINEZ",
        "authorized_official_first_name": "STEVE",
        "authorized_official_title_or_position": "INTERIM HOSPITAL ADMINISTRATOR",
        "authorized_official_telephone_number": "505-454-2100",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NM",
            "license": "76-135",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "03038",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "NM Behavioral Health Institute @ Las Vegas",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Vegas, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.