| Modern Vascular - Navajo Llc | |
|
7800 Constitution Ave Ne Albuquerque NM 87110-7552 | |
| (505) 278-9160 | |
| (505) 278-9170 |
| Full Name | Modern Vascular - Navajo Llc |
|---|---|
| Speciality | Radiology |
| Location | 7800 Constitution Ave Ne, Albuquerque, New Mexico |
| Authorized Official Name and Position | Yury Gampel (MANAGER) |
| Authorized Official Contact | 8188808605 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Modern Vascular - Navajo Llc 26500 Agoura Rd Ste 102-587 Calabasas CA 91302-1952 Ph: (818) 880-8605 | Modern Vascular - Navajo Llc 7800 Constitution Ave Ne Albuquerque NM 87110-7552 Ph: (505) 278-9160 |
| NPI Number | 1285126706 |
|---|---|
| Provider Enumeration Date | 05/31/2018 |
| Last Update Date | 04/05/2019 |
| Medicare PECOS PAC ID | 8426300344 |
|---|---|
| Medicare Enrollment ID | O20181004000125 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285126706 | NPI | - | NPPES |
| Provider Name | Heramb K Singh |
|---|---|
| Provider Type | Practitioner - Diagnostic Radiology |
| Provider Identifiers | NPI Number: 1023074127 PECOS PAC ID: 1355247925 Enrollment ID: I20040821000079 |
| Provider Name | Kent R Hootman |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1194707943 PECOS PAC ID: 8123125614 Enrollment ID: I20090831000380 |
| Provider Name | Michael W Keleher |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1770968257 PECOS PAC ID: 2466760525 Enrollment ID: I20151009000900 |
| Provider Name | Robert Frohmader |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609355536 PECOS PAC ID: 1153673421 Enrollment ID: I20181015002717 |
| Provider Name | Carol Jean Simpson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1447746011 PECOS PAC ID: 5193075562 Enrollment ID: I20190430001963 |
| Provider Name | Luis Nadal |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1720041510 PECOS PAC ID: 0547214710 Enrollment ID: I20200827003769 |
| Provider Name | Paul Rochon |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1598913980 PECOS PAC ID: 5193910875 Enrollment ID: I20221028001500 |
| Provider Name | Samuel Putnam |
|---|---|
| Provider Type | Practitioner - Interventional Radiology |
| Provider Identifiers | NPI Number: 1023066404 PECOS PAC ID: 5991699522 Enrollment ID: I20221129001682 |
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