Healthcare Provider Details

I. General information

NPI: 1174198220
Provider Name (Legal Business Name): THREE CROSSES MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/21/2021
Last Update Date: 09/21/2022
Certification Date: 09/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2550 SAMARITAN DR
LAS CRUCES NM
88001-1170
US

IV. Provider business mailing address

2560 SAMARITAN DR
LAS CRUCES NM
88001-1170
US

V. Phone/Fax

Practice location:
  • Phone: 575-800-3177
  • Fax: 575-652-5310
Mailing address:
  • Phone: 575-800-3177
  • Fax: 575-652-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOHN LANNING
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 575-339-4579