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Contact Information

MEDITELECARE OF NEW MEXICO, LLC
206 S CORONADO AVE
ESPAÑOLA, NM87532-2792
 Phone: 860-788-6404
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Psychiatry

2084P0800X 26 Physician/Psychiatry
 

Clinical

103TC0700X 62 Psychologist, Clinical
 

Clinical

1041C0700X 80 Licensed Clinical Social Worker
 

Geriatric Psychiatry

2084P0805X 86 Physician/Neuropsychiatry
 

Psychiatric/Mental Health

363LP0808X 50 Nurse Practitioner
Indicates primary specialty

NPI Profile & details for MEDITELECARE OF NEW MEXICO, LLC

NPI # 1629639729
LBN Legal business name MEDITELECARE OF NEW MEXICO, LLC
Authorized official ANDREA GODFREY - (CREDENTIALING & ENROLLMENT MANAGER)
Entity Organization
Organization subpart 1 No
Enumeration date 06/28/2019
Last updated 05/05/2025 - More than a year ago
Identifiers n/a
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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