NPIMap

Organization Active NPI

PHC Las Cruces Inc.

Doing business as Memorial Medical Center-Ikard Cancer Center

  • Specialist
  • Las Cruces, NM
National Provider Identifier
1497069397
Registry record updated Apr 13, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
Legal business name
PHC LAS CRUCES INC.
Doing business as
Memorial Medical Center-Ikard Cancer Center
Practice address
2450 S Telshor Blvd
Ste E
Las Cruces, NM 88011-5069
Phone
(575) 556-5800
Fax
(575) 556-5899
NPI assigned
Aug 3, 2010
Last updated
Apr 13, 2016By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 13, 2016

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

Authorized official

Name
Sarah Wellborn, MHA, CPC-A, CEMC
Title
Practice Management Director
Phone
(575) 521-5460

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X Primary

Addresses

Primary practice location

2450 S Telshor Blvd
Ste E
Las Cruces, NM 88011-5069

Mailing address

PO Box 6310
Las Cruces, NM 88006-6310
Phone (575) 556-5960

Other names 1

  • Memorial Medical Center-Ikard 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.

Locations

2430 S Telshor Blvd Ste 201
Las Cruces, NM 88011

2450 S Telshor Blvd
Ste E
Las Cruces, NM 88011
Phone (575) 556-5800

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": "1280793600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1460505600000",
    "number": "1497069397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 6310",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880066310",
            "telephone_number": "575-556-5960",
            "fax_number": "575-556-5959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 S TELSHOR BLVD",
            "address_2": "STE E",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880115069",
            "telephone_number": "575-556-5800",
            "fax_number": "575-556-5899"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC LAS CRUCES INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-08-03",
        "last_updated": "2016-04-13",
        "status": "A",
        "authorized_official_last_name": "WELLBORN",
        "authorized_official_first_name": "SARAH",
        "authorized_official_title_or_position": "PRACTICE MANAGEMENT DIRECTOR",
        "authorized_official_telephone_number": "575-521-5460",
        "authorized_official_credential": "MHA, CPC-A, CEMC"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Memorial Medical Center-Ikard 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 Apr 13, 2016; 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.