NPIMap

PHC Las Cruces Inc.

Organization Active NPI Specialist · Las Cruces, NM

NPI 1497069397 · NPPES record last updated Apr 13, 2016

Key facts

NPI
1497069397
Entity type
Organization (NPI type 2)
Primary specialty
Specialist 174400000X
Legal business name
PHC LAS CRUCES INC.
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
Organization subpart
No

Authorized official

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

Other NPIs on the same Medicare enrollment 3

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

Corporate family (same tax ID) 10

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

Practitioners 24

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

Medicare participation

Medicare fee-for-service enrollment
Enrolled in NM

Medicare enrollment records

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

National Provider Directory

Tax ID family
Memorial Medical Center (11 organizations share this tax ID)

Locations

4650 Jefferson Ln NE
Albuquerque, NM 87109
Phone (505) 727-7900

2430 S Telshor Blvd Ste 201
Las Cruces, NM 88011

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist
Group: 193400000X SINGLE SPECIALTY GROUP		 174400000X Yes

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

  • Memorial Medical Center-Ikard Cancer Center Doing business as

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Apr 13, 2016.

{
    "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": "193400000X SINGLE SPECIALTY  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

All providers in Las Cruces, NM · Specialist in New Mexico

Sources for this page

Verify at the official NPI Registry.