NPIMap

Organization Active NPI

Pangea Medical LLC

  • Adult Mental Health Clinic/Center
  • Roswell, NM
National Provider Identifier
1457619934
Registry record updated May 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X
License
MD2011-0547 Issued in NM
Legal business name
PANGEA MEDICAL LLC
Practice address
2604 Gaye Dr
Roswell, NM 88201-3427
Phone
(575) 578-4548
NPI assigned
May 2, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 2, 2012

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

Authorized official

Name
Steven Ray Black
Title
M.D.
Phone
(575) 578-4548

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X MD2011-0547 NM Primary
Primary Care Clinic/Center 261QP2300X MD2011-0547 NM

Addresses

Primary practice location

2604 Gaye Dr
Roswell, NM 88201-3427

Mailing address

2604 Gaye Dr
Roswell, NM 88201-3427
Phone (575) 578-4548

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1335916800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1335916800000",
    "number": "1457619934",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2604 GAYE DR",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882013427",
            "telephone_number": "575-578-4548"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2604 GAYE DR",
            "city": "ROSWELL",
            "state": "NM",
            "postal_code": "882013427",
            "telephone_number": "575-578-4548"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PANGEA MEDICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-05-02",
        "last_updated": "2012-05-02",
        "status": "A",
        "authorized_official_last_name": "BLACK",
        "authorized_official_first_name": "STEVEN",
        "authorized_official_middle_name": "RAY",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "575-578-4548"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NM",
            "license": "MD2011-0547",
            "primary": true
        },
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "NM",
            "license": "MD2011-0547",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Roswell, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.