Healthcare Provider Details

I. General information

NPI: 1891076519
Provider Name (Legal Business Name): AGAPE PAIN MANAGEMENT AND ANESTHESIA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/08/2011
Last Update Date: 12/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2170 E LOHMAN AVE SUITE C
LAS CRUCES NM
88001-8411
US

IV. Provider business mailing address

2170 E LOHMAN AVE SUITE C
LAS CRUCES NM
88001-8411
US

V. Phone/Fax

Practice location:
  • Phone: 575-449-7002
  • Fax: 575-652-4684
Mailing address:
  • Phone: 575-449-7002
  • Fax: 575-652-4684

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD2010-0116
License Number StateNM

VIII. Authorized Official

Name: DR. LLEWELYN WILLIAMS
Title or Position: MD/OWNER
Credential:
Phone: 575-449-7002