Healthcare Provider Details

I. General information

NPI: 1215920426
Provider Name (Legal Business Name): NEW MEXICO BRAIN INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 10/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 COTTONWOOD DR
ALAMOGORDO NM
88310-8219
US

IV. Provider business mailing address

108 COTTONWOOD DR
ALAMOGORDO NM
88310-8219
US

V. Phone/Fax

Practice location:
  • Phone: 575-434-0901
  • Fax: 575-437-1992
Mailing address:
  • Phone: 575-434-0901
  • Fax: 575-437-1992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN PAUL SIMMONS
Title or Position: PRESIDENT/PHYSICIAN
Credential: MD
Phone: 505-434-0901