Provider Demographics
NPI:1447355458
Name:CENTER FOR REPRODUCTIVE MEDICINE OF NEW MEXICO
Entity type:Organization
Organization Name:CENTER FOR REPRODUCTIVE MEDICINE OF NEW MEXICO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-224-7474
Mailing Address - Street 1:201 CEDAR SE
Mailing Address - Street 2:SUITE SI-20
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4900
Mailing Address - Country:US
Mailing Address - Phone:505-224-7474
Mailing Address - Fax:505-224-7476
Practice Address - Street 1:201 CEDAR SE
Practice Address - Street 2:SUITE SI-20
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4900
Practice Address - Country:US
Practice Address - Phone:505-224-7474
Practice Address - Fax:505-224-7476
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Not Answered207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB4751Medicaid