New Mexico PHS LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

NEW MEXICO PHS LLC

Practice address

9155 Crestwyn Hills Dr
Memphis, TN 38125-8501

Phone

(901) 261-4848

Fax

(901) 261-4849

NPI assigned

Oct 5, 2010

Last updated

Oct 5, 2010By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Theresa Nicholas

Title

Credentialing Manager

Phone

(901) 261-4858

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1286236800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1286236800000",
    "number": "1871802082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6565 AMERICAS PKWY NE STE 200",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871108172"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9155 CRESTWYN HILLS DR",
            "city": "MEMPHIS",
            "state": "TN",
            "postal_code": "381258501",
            "telephone_number": "901-261-4848",
            "fax_number": "901-261-4849"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW MEXICO PHS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-10-05",
        "last_updated": "2010-10-05",
        "status": "A",
        "authorized_official_last_name": "NICHOLAS",
        "authorized_official_first_name": "THERESA",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "901-261-4858"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2010; 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.