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NPI Code Detail

MEDICARE: ANTHONY CHARLES MASON COMMUNITY SUPPORT WO

MEDICARE: ANTHONY CHARLES MASON COMMUNITY SUPPORT WO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1174096945
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANTHONY CHARLES MASON COMMUNITY SUPPORT WO
Provider Business Mailing Address
First Line : 159 SHAWNEE
Second Line :
City : LAS CRUCES
State : NM
Zip : 88007-1144
Country : US
Telephone Number : 575-296-4990
Fax Number : 575-522-9017
Provider Business Practice Location Address
First Line : 1320 S SOLANO DR
Second Line :
City : LAS CRUCES
State : NM
Zip : 88001-3758
Country : US
Telephone Number : 575-522-4004
Fax Number : 575-522-9017
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/04/2019
Last Update Date : 02/04/2026

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