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Contact Information

STATE OF NEW MEXICO
3695 HOT SPRINGS BLVD
LAS VEGAS, NM87701-9549
 Phone: 505-454-2183
 Fax: 505-454-2182
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Institutional Pharmacy

3336I0012X 58 Medical Supply Company with Pharmacist
 

Long Term Care Pharmacy

3336L0003X 58 Medical Supply Company with Pharmacist
 

Pharmacy

333600000X 58 Medical Supply Company with Pharmacist
Indicates primary specialty

NPI Profile & details for STATE OF NEW MEXICO

NPI # 1598966798
LBN Legal business name STATE OF NEW MEXICO
Authorized official DAN SMITH - (PHARMACY DIRECTOR)
Entity Organization
Organization subpart 1 No
Enumeration date 05/29/2007
Last updated 10/04/2016 - About 10 years ago
Identifiers
NM License # PH00002105
NM Medicaid 61788
Other 2056964 PK
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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