| Monogram Health Professional Services Of New Mexico Llc | |
|
500 Marquette Ave Nw Ste 1200 Albuquerque NM 87102-5312 | |
| (615) 673-4455 | |
| Not Available |
| Full Name | Monogram Health Professional Services Of New Mexico Llc |
|---|---|
| Speciality | Internal Medicine |
| Location | 500 Marquette Ave Nw Ste 1200, Albuquerque, New Mexico |
| Authorized Official Name and Position | Shawn Verner (GENERAL COUNSEL AND SECRETARY) |
| Authorized Official Contact | 6159941889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Monogram Health Professional Services Of New Mexico Llc 5410 Maryland Way Ste 301 Brentwood TN 37027-5339 Ph: (615) 673-4455 | Monogram Health Professional Services Of New Mexico Llc 500 Marquette Ave Nw Ste 1200 Albuquerque NM 87102-5312 Ph: (615) 673-4455 |
| NPI Number | 1831804699 |
|---|---|
| Provider Enumeration Date | 01/17/2023 |
| Last Update Date | 01/17/2023 |
| Medicare PECOS PAC ID | 5395110480 |
|---|---|
| Medicare Enrollment ID | O20230403001057 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831804699 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Shaminder Gupta |
|---|---|
| Provider Type | Practitioner - Nephrology |
| Provider Identifiers | NPI Number: 1730183401 PECOS PAC ID: 1658322300 Enrollment ID: I20230403001214 |
| Provider Name | Keith Deardorff |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801131057 PECOS PAC ID: 2062717028 Enrollment ID: I20230511003339 |
| Provider Name | Jordan Montoya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1881173037 PECOS PAC ID: 1951779289 Enrollment ID: I20230614000294 |
| Provider Name | Michelle Boudria |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578641445 PECOS PAC ID: 4789786419 Enrollment ID: I20231101000853 |
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