PHC Las Cruces
Organization Active NPI Hematology & Oncology Physician · Las Cruces, NM
NPI 1376774489 · NPPES record last updated Aug 6, 2009
Key facts
- NPI
- 1376774489
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Hematology & Oncology Physician 207RH0003X
- Legal business name
- PHC LAS CRUCES
- Practice address
- 2530 S Telshor Blvd
Suite 201
Las Cruces, NM 88011-4907 - Phone
- (575) 521-5277
- NPI assigned
- Aug 6, 2009
- Organization subpart
- No
Authorized official
- Name
- Angie Mangum
- Title
- Director
- Phone
- (575) 521-5277
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 10
Practitioners 24
-
John Andazola, M.D.
-
Natasha Beachum, MD
-
Jason Andrew Call, M.D.
-
Davin C Craig, DNP, PMHNP-BC
-
Michelle Lea Galindo, CNP
-
Salvador Hernandez, NP-C
-
Christina Lucero, FNP-BC
-
Stephanie Rose Lynch, FNP
-
Mai H Oushy, MD
-
John Glenn Scott, M.D., PH.D.
-
Lesley C Snelling, M.D.
-
Lynne A Bui, M.D.
-
Ulista Hoover, M.D.
-
Tariq Mahmood, M.D.
-
Minerva Medrano, MD
-
Heather D Owens, MD
-
Joel A Reyes, D.O.
-
Eric Sandoval, MD
-
Madhu Unnikrishnan, MBBS
-
Shawn Watts, MD
-
Clinton R Woosley, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20040624000297 | NM | Part B Supplier - Clinic/Group Practice | 4486635802 |
Receives reassigned benefits from 70 practitioners 3 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Las Cruces, NM |
National Provider Directory
- Tax ID family
- Memorial Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Hematology & Oncology Physician |
207RH0003X | Yes |
Addresses
Primary practice location
2530 S Telshor Blvd
Suite 201
Las Cruces, NM 88011-4907
Mailing address
2450 S Telshor Blvd
Las Cruces, NM 88011-5069
Phone (575) 521-5277
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 26001373 | Medicaid | NM |
Other names
- MMC Cancer Center
Other providers in Las Cruces, NM
- Sandra Peugh
- Robin Taylor Pfaff
- Aaron Pfau
- Pharmtrue Pharmacy DTLC LLC
- Pharmtrue Pharmacy DTLC LLC
- PHC Las Cruces
- PHC Las Cruces Inc
- PHC Las Cruces Inc.
- PHC Las Cruces Memorial Medical Center Family Practice Center
- PHC Las Cruces, Inc
All providers in Las Cruces, NM · Hematology & Oncology Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 6, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.