NPIMap

Organization Active NPI

Optumcare Endoscopy Center New Mexico, LLC

Doing business as DaVita Medical Endoscopy

  • Ambulatory Surgical Clinic/Center
  • Albuquerque, NM
National Provider Identifier
1962685834
Registry record updated Feb 12, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
PENDING Issued in NM
Legal business name
OPTUMCARE ENDOSCOPY CENTER NEW MEXICO, LLC
Doing business as
DaVita Medical Endoscopy
Practice address
5400 Gibson Blvd SE
Floor 2; Elevator C
Albuquerque, NM 87108-4729
Phone
(505) 262-7174
Fax
(505) 262-3562
NPI assigned
Dec 13, 2007
Last updated
Feb 12, 2020By the provider in NPPES
Organization subpart
Yes
Parent organization
DAVITA MEDICAL GROUP NEW MEXICO, LLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Feb 12, 2020

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
Ambulatory Surgical Clinic/Center 261QA1903X PENDING NM Primary

Addresses

Primary practice location

5400 Gibson Blvd SE
Floor 2; Elevator C
Albuquerque, NM 87108-4729

Mailing address

PO Box 912680
Denver, CO 80291-4729
Phone (505) 262-7000

Other names 1

  • DaVita Medical Endoscopy Doing business as

National Provider Directory

National Provider Directory
Part of
Lovelace Healthcare Center-Santa Fe

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 314

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 314

NPI Registry JSON

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

{
    "created_epoch": "1197504000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1581465600000",
    "number": "1962685834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 912680",
            "city": "DENVER",
            "state": "CO",
            "postal_code": "802914729",
            "telephone_number": "505-262-7000",
            "fax_number": "505-262-7652"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5400 GIBSON BLVD SE",
            "address_2": "FLOOR 2; ELEVATOR C",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871084729",
            "telephone_number": "505-262-7174",
            "fax_number": "505-262-3562"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "OPTUMCARE ENDOSCOPY CENTER NEW MEXICO, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "DAVITA MEDICAL GROUP NEW MEXICO, LLC",
        "enumeration_date": "2007-12-13",
        "last_updated": "2020-02-12",
        "certification_date": "2020-02-12",
        "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": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "NM",
            "license": "PENDING",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DaVita Medical Endoscopy",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "DaVita Medical Endoscopy",
            "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 Feb 12, 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.