OPTUMCARE NEW MEXICO LLC NPI 1245494723

NPI Information

  • NPI: 1245494723
  • Provider Name: OPTUMCARE NEW MEXICO, LLC
  • Classification: Radiologic Technologist - 247100000X
  • Entity Type: Organization
  • Doing Business As: DAVITA MEDICAL GROUP
  • Address: 5150 JOURNAL CENTER BLVD NE
    ALBUQUERQUE, NM
    ZIP 87109
  • Phone: (505) 232-1500

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NPI Details

OPTUMCARE NEW MEXICO, LLC is a radiologic technologist in Albuquerque, NM. The provider is a medical imaging or radiation therapy professional who is appropriately educated and trained to perform medical imaging procedures using ionizing and nonionizing radiation. OPTUMCARE NEW MEXICO, LLC NPI is 1245494723. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Is Doing Business As Davita Medical Group.

The provider's business location address is:

5150 JOURNAL CENTER BLVD NE
ALBUQUERQUE, NM
ZIP 87109-900
Phone: (505) 232-1500
Fax: (505) 232-1584

The provider's authorized official is John G Liethen .
The authorized official title is Secretary and has the following contact phone number (952) 205-6262.

The enumeration date for this NPI number is 7/15/2008 and was last updated on 8/20/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12471V0105XRadiologic TechnologistVascular SonographyNo
22471V0106XRadiologic TechnologistVascular-Interventional TechnologyNo
32471B0102XRadiologic TechnologistBone DensitometryNo
42471C3401XRadiologic TechnologistComputed TomographyNo
52471C3402XRadiologic TechnologistRadiographyNo
62471M1202XRadiologic TechnologistMagnetic Resonance ImagingNo
72471M2300XRadiologic TechnologistMammographyNo
82471S1302XRadiologic TechnologistSonographyNo
9247100000XRadiologic TechnologistYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
193670567MEDICAIDNEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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