Healthcare Provider Details

I. General information

NPI: 1346586195
Provider Name (Legal Business Name): LAS CRUCES PHYSICIAN PRACTICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2012
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1160 MALL DR SUITE 100
LAS CRUCES NM
88011-8128
US

IV. Provider business mailing address

1160 MALL DR SUITE 100
LAS CRUCES NM
88011-8128
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3270
  • Fax: 575-521-3504
Mailing address:
  • Phone: 575-521-3270
  • Fax: 575-521-3504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLOTTE LAWRENCE
Title or Position: SECRETARY
Credential:
Phone: 615-920-7000