Organization · NPI-2

Endovascular

Surgery · Gallup, NM

NPI number1972221182
StatusActive
Last updated in NPPESSep 8, 2022

Details

NPI
1972221182
Entity type
Organization (NPI-2)
Legal business name
Endovascular
Organization subpart
No
Enumeration date
Aug 15, 2022
Certification date
Sep 8, 2022
Last updated
Sep 8, 2022

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
208600000X Surgery––Yes
207QB0002X Family Medicine, Bariatric Medicine––
213ES0103X Podiatrist, Foot & Ankle Surgery––

Other names

  • Endovascular (Other Name)

Practice location

2240 College Dr
Gallup, NM 87301-7003

Phone 505-297-1052 · Fax 505-297-1227

Mailing address

202 E Earll Dr Ste 360
Phoenix, AZ 85012-2677

Phone 480-788-5621 · Fax 480-779-1277

Authorized official

Kiup Alexander Kim
Chief Medical Officer
4805842369

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