Healthcare Provider Details

I. General information

NPI: 1790041168
Provider Name (Legal Business Name): ARTHRITIS TREATMENT SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/10/2012
Last Update Date: 05/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 TIERRA DE MESILLA
LA MESILLA NM
88046
US

IV. Provider business mailing address

PO BOX 1268
MESILLA NM
88046-1268
US

V. Phone/Fax

Practice location:
  • Phone: 575-526-9189
  • Fax: 575-652-4064
Mailing address:
  • Phone: 575-526-9189
  • Fax: 575-652-4064

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD2006-0771
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberN8041
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License NumberMD2006-0771
License Number StateNM

VIII. Authorized Official

Name: DR. ADRIAN A MICHAEL
Title or Position: CEO/OWNER
Credential: M.D.
Phone: 575-526-9189