Bethphage Mission West
Organization Active NPI Specialist · Grants, NM
NPI 1649482639 · NPPES record last updated Aug 22, 2020
Key facts
- NPI
- 1649482639
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Specialist 174400000X
- Legal business name
- BETHPHAGE MISSION WEST
- Practice address
- 920 Lobo Canyon Rd
Suite 5a
Grants, NM 87020-2173 - Phone
- (505) 287-9333
- Fax
- (505) 287-9336
- NPI assigned
- May 4, 2007
- Organization subpart
- No
Authorized official
- Name
- Dean Wilson
- Title
- VP Accounting
- Phone
- (402) 896-3884
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | NM | Yes |
Addresses
Primary practice location
920 Lobo Canyon Rd
Suite 5a
Grants, NM 87020-2173
Mailing address
4980 S 118TH St
Omaha, NE 68137-2220
Phone (402) 896-3884
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| D0103 | Medicaid | NM |
Other providers in Grants, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 22, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.