NPIMap

Organization Active NPI

PHC Las Cruces

Doing business as MMC Cancer Center

  • Hematology & Oncology Physician
  • Las Cruces, NM
National Provider Identifier
1376774489
Registry record updated Aug 6, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Hematology & Oncology PhysicianTaxonomy code 207RH0003X
Legal business name
PHC LAS CRUCES
Doing business as
MMC Cancer Center
Practice address
2530 S Telshor Blvd
Suite 201
Las Cruces, NM 88011-4907
Phone
(575) 521-5277
NPI assigned
Aug 6, 2009
Last updated
Aug 6, 2009By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 6, 2009

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Angie Mangum
Title
Director
Phone
(575) 521-5277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Hematology & Oncology Physician 207RH0003X Primary

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 1

IdentifierTypeStateIssuer
26001373MedicaidNM

Other names 1

  • MMC Cancer Center Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
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

Other NPIs on the same Medicare enrollment 3

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

National Provider Directory

National Provider Directory
Tax ID family
PHC Las Cruces Memorial Medical Center Family Practice Center11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 24

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1249516800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1249516800000",
    "number": "1376774489",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 S TELSHOR BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880115069",
            "telephone_number": "575-521-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2530 S TELSHOR BLVD",
            "address_2": "SUITE 201",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880114907",
            "telephone_number": "575-521-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC LAS CRUCES",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-08-06",
        "last_updated": "2009-08-06",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "575-521-5277"
    },
    "taxonomies": [
        {
            "code": "207RH0003X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Hematology & Oncology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "26001373",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "MMC Cancer Center",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Las Cruces, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 6, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.