Healthcare Provider Details

I. General information

NPI: 1497069397
Provider Name (Legal Business Name): PHC LAS CRUCES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/03/2010
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S TELSHOR BLVD STE E
LAS CRUCES NM
88011-5069
US

IV. Provider business mailing address

PO BOX 6310
LAS CRUCES NM
88006-6310
US

V. Phone/Fax

Practice location:
  • Phone: 575-556-5800
  • Fax: 575-556-5899
Mailing address:
  • Phone: 575-556-5960
  • Fax: 575-556-5959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: SARAH WELLBORN
Title or Position: PRACTICE MANAGEMENT DIRECTOR
Credential: MHA, CPC-A, CEMC
Phone: 575-521-5460