NPIMap

Organization Active NPI

PHC Las Cruces Inc

Doing business as ID Consultants

  • Infectious Disease Physician
  • Las Cruces, NM
National Provider Identifier
1942581202
Registry record updated Aug 31, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Infectious Disease PhysicianTaxonomy code 207RI0200X
Legal business name
PHC LAS CRUCES INC
Doing business as
ID Consultants
Practice address
2450 S Telshor Blvd
Las Cruces, NM 88011-5069
Phone
(575) 521-5277
NPI assigned
Aug 31, 2011
Last updated
Aug 31, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 31, 2011

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

Authorized official

Name
Angie Mangum
Title
Director
Phone
(575) 521-5277

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Infectious Disease PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RI0200X Primary

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 1

  • ID Consultants 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 Cruces11 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

1401 S Don Roser Dr
Ste C
Las Cruces, NM 88011
Phone (505) 532-1006

160 N Roadrunner Pkwy
Las Cruces, NM 88011
Phone (505) 522-1802

840 N Telshor Blvd
Ste G
Las Cruces, NM 88011
Phone (505) 556-6500

Practitioners & affiliated clinicians

Practitioners 69

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 69

NPI Registry JSON

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

{
    "created_epoch": "1314748800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1314748800000",
    "number": "1942581202",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2450 S TELSHOR BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880115069",
            "telephone_number": "575-521-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2450 S TELSHOR BLVD",
            "city": "LAS CRUCES",
            "state": "NM",
            "postal_code": "880115069",
            "telephone_number": "575-521-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHC LAS CRUCES INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-31",
        "last_updated": "2011-08-31",
        "status": "A",
        "authorized_official_last_name": "MANGUM",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "DIRECTOR",
        "authorized_official_telephone_number": "575-521-5277"
    },
    "taxonomies": [
        {
            "code": "207RI0200X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Infectious Disease",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ID Consultants",
            "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 Aug 31, 2011; 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.