Healthcare Provider Details

I. General information

NPI: 1013900794
Provider Name (Legal Business Name): RIO GRANDE MEDICAL GROUP, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2005
Last Update Date: 11/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

4371 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-8900
  • Fax: 575-532-8910
Mailing address:
  • Phone: 575-532-8900
  • Fax: 575-532-8910

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. HASAN ADNAN
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 575-532-8900