Healthcare Provider Details

I. General information

NPI: 1306942958
Provider Name (Legal Business Name): PACE MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3800 E LOHMAN AVE SUITE A
LAS CRUCES NM
88011-8273
US

IV. Provider business mailing address

3800 E LOHMAN AVE SUITE A
LAS CRUCES NM
88011-8273
US

V. Phone/Fax

Practice location:
  • Phone: 505-522-6500
  • Fax: 505-522-0591
Mailing address:
  • Phone: 505-522-6500
  • Fax: 505-522-0591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number94250
License Number StateNM

VIII. Authorized Official

Name: DR. EDDIE L GAINES
Title or Position: PRESIDENT
Credential: MD
Phone: 505-522-6500