PHC Las Cruces Inc
Organization Active NPI Infectious Disease Physician · Las Cruces, NM
NPI 1942581202 · NPPES record last updated Aug 31, 2011
Key facts
- NPI
- 1942581202
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Infectious Disease Physician 207RI0200X
- Legal business name
- PHC LAS CRUCES INC
- Practice address
- 2450 S Telshor Blvd
Las Cruces, NM 88011-5069 - Phone
- (575) 521-5277
- NPI assigned
- Aug 31, 2011
- Organization subpart
- No
Authorized official
- Name
- Angie Mangum
- Title
- Director
- Phone
- (575) 521-5277
Other NPIs on the same Medicare enrollment 3
Corporate family (same tax ID) 10
Practitioners 70
-
John Andazola, M.D.
-
Kerry Atkinson, CNP
-
Natasha Beachum, MD
-
Daubney M Boland, PHD
-
Jason Andrew Call, M.D.
-
Stephen Colmant, PH.D.
-
Melissa J Cometti, DNP, NP-C
-
Davin C Craig, DNP, PMHNP-BC
-
Joseph Graham Ewing, M.D.
-
Michelle Lea Galindo, CNP
-
Dolores M Gomez, MD
-
Salvador Hernandez, NP-C
-
Clarissa C Juarez, CNP
-
Christina Lucero, FNP-BC
-
Stephanie Rose Lynch, FNP
-
Mai H Oushy, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| 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
Locations
840 N Telshor Blvd
Ste G
Las Cruces, NM 88011
Phone (505) 556-6500
2450 S Telshor Blvd
Ste B
Las Cruces, NM 88011
Phone (575) 556-5800
1401 S Don Roser Dr
Ste C
Las Cruces, NM 88011
Phone (505) 532-1006
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Infectious Disease Physician |
207RI0200X | Yes |
Addresses
Primary practice location
2450 S Telshor Blvd
Las Cruces, NM 88011-5069
Mailing address
2450 S Telshor Blvd
Las Cruces, NM 88011-5069
Phone (575) 521-5277
Other names
- ID Consultants
Other providers in Las Cruces, NM
- Aaron Pfau
- Pharmtrue Pharmacy DTLC LLC
- Pharmtrue Pharmacy DTLC LLC
- PHC Las Cruces
- PHC Las Cruces
- PHC Las Cruces Inc.
- PHC Las Cruces Memorial Medical Center Family Practice Center
- PHC Las Cruces, Inc
- PHC-Las Cruces Inc
- PHC-Las Cruces Inc
All providers in Las Cruces, NM · Infectious Disease Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 31, 2011. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.