Healthcare Provider Details

I. General information

NPI: 1629014543
Provider Name (Legal Business Name): ORGAN MOUNTAINS CARDIOLOGY, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE SUITE 101
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

4351 E LOHMAN AVE SUITE 101
LAS CRUCES NM
88011-8259
US

V. Phone/Fax

Practice location:
  • Phone: 505-532-1155
  • Fax: 505-532-5771
Mailing address:
  • Phone: 505-532-1155
  • Fax: 505-532-5771

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberNM97109
License Number StateNM

VIII. Authorized Official

Name: RICHARD S MELTZER
Title or Position: PRESIDENT
Credential: MD
Phone: 505-532-1155