Provider Demographics
NPI:1871584730
Name:NEW MEXICO CLINICAL RESEARCH & OSTEOPOROSIS CENTER, INC
Entity type:Organization
Organization Name:NEW MEXICO CLINICAL RESEARCH & OSTEOPOROSIS CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:E
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:LEWIECKI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-855-5525
Mailing Address - Street 1:300 OAK ST NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-4725
Mailing Address - Country:US
Mailing Address - Phone:505-855-5525
Mailing Address - Fax:505-884-4006
Practice Address - Street 1:300 OAK ST NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-4725
Practice Address - Country:US
Practice Address - Phone:505-855-5525
Practice Address - Fax:505-884-4006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2007-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z5691Medicaid