Healthcare Provider Details

I. General information

NPI: 1295728301
Provider Name (Legal Business Name): LUNG & SLEEP ASSOCIATES OF LAS CRUCES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2005
Last Update Date: 07/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2735 NORTHRISE DR
LAS CRUCES NM
88011-0897
US

IV. Provider business mailing address

205 W BOUTZ RD BLDG 1
LAS CRUCES NM
88005-3262
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-4344
  • Fax: 575-532-4347
Mailing address:
  • Phone: 575-532-7000
  • Fax: 575-556-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES P BRADLEY
Title or Position: OWNER
Credential: MD
Phone: 575-532-4344