SHANE NEWSOM (NPI# 1578184990) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1578184990 |
| Entity Type | Individual |
| Full Name | SHANE NEWSOM |
| Credential | 390200000X |
| Practice Address |
12300 Modesto Ave Ne Albuquerque NM 87122-2232 |
| Practice Telephone | 5055534835 |
| Mailing Telephone | 5055534835 |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2020-04-27 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 171W00000X | Contractor | Other Service Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| STUDENT | 390200000X | 01 |
| Street Address |
12300 MODESTO AVE NE |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87122-2232 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700426988 | Sophia Khalil | Student in an Organized Health Care Education/Training Program | 11128 Jordan Avenue Northeast, Albuquerque, NM 87122 | 2020-01-15 |
| 1457716664 | Raymond Martinez | Pharmacist | 7847 Tramway Ne, Albuquerque, NM 87122 | 2015-12-15 |
| 1891181913 | Paul Wright | Occupational Therapist | 30 Canocito Drive Ne, Albuquerque, NM 87122 | 2015-04-15 |
| 1356736615 | Tracy Pfeifer | Day Training/Habilitation Specialist | 8920 Holly Avenue Ne, Suite 102b, Albuquerque, NM 87122 | 2015-04-03 |
| 1346595071 | Jonathan Harper Kelley | Dentist | 9015 Paseo Del Norte Ne Ste A, Albuquerque, NM 87122 | 2012-07-18 |
| 1639444946 | Charlsey Leigh Mcdonald | Physical Therapist | 7920 Carmel Ave. Ne, Suite 2, Albuquerque, NM 87122 | 2012-03-20 |
| 1235462250 | Pamela Kay Limke | Pharmacist | 12112 Summer Wind Pl Ne, Albuquerque, NM 87122 | 2009-09-09 |
| 1437395332 | High Desert Pedicatrics PC | Pediatrics | 8650 Almeda Boulevard, Ne, Unit 101 E, Albuquerque, NM 87122 | 2008-12-23 |
| 1952427510 | Thomas Harry Heflin | Dentist | 8000 Carmel Ave, Albuquerque, NM 87122 | 2007-03-22 |
| 1497885032 | Thomas H Heflin Dds Pa | Dentist | 8000 Carmel Avenue Ne, Albuquerque, NM 87122 | 2007-03-06 |
| Find all providers in zip 87122 | ||||
| Taxonomy Code | 171W00000X |
| Grouping | Other Service Providers |
| Classification | Contractor |
| A person who contracts to supply certain materials or do certain work for a stipulated sum; esp., one whose business is contracting work in any of the building trades. For purposes of the taxonomy, a person who contracts to complete home repairs or modifications to accommodate a health condition (e.g. wheelchair ramp, kitchen counter lowering). |
| Notes: Source: Websters New World Dictionary of the American Language, Second College Edition, William Collins + World Publishing Co., Inc., New York: 1974, p. 308 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1972158327 | Caroline Telles | Contractor | 2929 Coors Blvd Nw Ste 307e, Albuquerque, NM 87120-1173 | 2019-08-02 |
| 1457834681 | Medical Practice Solutions | Contractor | 4501 Osuna Rd Ne, Albuquerque, NM 87109-4467 | 2018-09-13 |
| 1275067449 | Lorraine A Romo | Contractor | 10616 Teal Rd Sw, Albuquerque, NM 87121-8464 | 2017-04-14 |
| 1932646577 | Mark P Hogan | Contractor | 806 Delamar Ave Nw, Albuquerque, NM 87107-5122 | 2017-01-20 |
| 1629527478 | Jeanette Moore | Contractor | 7408 Estes Park Ave Nw, Albuquerque, NM 87114-3944 | 2016-09-21 |
| 1841661535 | Chris Martinez | Contractor | 2505 Graceland Dr Ne Unit 35104, Albuquerque, NM 87176-7606 | 2015-10-07 |
| 1154723294 | Jane Volkmer | Contractor | 6109 Jamers Dr Nw, Albuquerque, NM 87120-3217 | 2014-09-19 |
| 1609282144 | Karen Marie Zezza-vinyard | Contractor | 6540 Ancients Rd Nw, Albuquerque, NM 87114-6111 | 2014-07-04 |
| 1568808947 | Daniel Glen Kimura | Contractor | 2201 Ambassador Rd Ne Apt 206, Albuquerque, NM 87112-2749 | 2013-05-13 |
| 1922358670 | Dale Williams Jr. | Contractor | 6150 Alvis Cir Sw, Albuquerque, NM 87105-6869 | 2012-09-10 |
| Find all providers in ALBUQUERQUE | ||||
| City | ALBUQUERQUE |
| Zip Code | 87122 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.