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 |
| 1 | 335E00000X | Prosthetic/Orthotic Supplier | | FA0048723 | NEW MEXICO | Yes |
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 |
| 1 | NMOOTA31 | OTHER | NEW MEXICO | BLUECROSS BLUESHIELD NM |
| 2 | ========= | OTHER | ARIZONA | SOUTHWEST SERVICE ADM-ALB |
| 3 | ========= | OTHER | NEBRASKA | MUTUAL OF OMAHA |
| 4 | ========= | OTHER | NEW MEXICO | SMWIA LOCAL 49 |
| 5 | ========= | OTHER | NEW MEXICO | CCMSI OF NM |
| 6 | ========= | OTHER | NEW MEXICO | AETNA PROVIDER NUMBER |
| 7 | ========= | OTHER | NEW MEXICO | LOVELACE HEALTH PLAN |
| 8 | ========= | OTHER | CONNECTICUT | CIGNA HEALTHCARE |
| 9 | ========= | OTHER | NEW MEXICO | HEALTHSOUTH REHAB |
| 10 | 4940610001 | MEDICARE ID-TYPE UNSPECIFIED | TENNESSEE | ARIZONA CIGNA MEDICARE |
| 11 | 4940610001 | MEDICARE ID-TYPE UNSPECIFIED | SOUTH CAROLINA | PALMETTO GBA - NEW MEXICO |
| 12 | 957699 | MEDICAID | ARIZONA | |
| 13 | ========= | OTHER | KENTUCKY | UNITED HEALTHCARE |
| 14 | ========= | MEDICARE ID-TYPE UNSPECIFIED | NEW MEXICO | LOVELACE SENIOR OPTIONS |
| 15 | ========= | MEDICAID | NEW MEXICO | |
| 16 | 33680825 | MEDICAID | NEW MEXICO | |
