MEDICARE: EL CALVARIO UNITED METHODIST CHURCH

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
1	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1871457689
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL CALVARIO UNITED METHODIST CHURCH

Provider Business Mailing Address
First Line	:	240 N MESQUITE ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3527
Country	:	US
Telephone Number	:	575-523-0142
Fax Number	:

Provider Business Practice Location Address
First Line	:	240 N MESQUITE ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-3527
Country	:	US
Telephone Number	:	575-523-0142
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	GEORGE MILLER
Credential	:	REV
Telephone Number	:	360-674-9822

Provider Enumeration Date	:	12/15/2025
Last Update Date	:	12/15/2025

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