Healthcare Provider Details

I. General information

NPI: 1356954648
Provider Name (Legal Business Name): ASC OF THE HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 01/21/2021
Certification Date: 01/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N SONOMA RANCH BLVD
LAS CRUCES NM
88011
US

IV. Provider business mailing address

3640 JOE BATTLE BLVD STE 100
EL PASO TX
79938-2628
US

V. Phone/Fax

Practice location:
  • Phone: 575-323-3010
  • Fax:
Mailing address:
  • Phone: 915-313-4949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LOOKMAN LAWAL
Title or Position: CEO/PHYSICIAN
Credential: MD
Phone: 502-409-2892