Healthcare Provider Details

I. General information

NPI: 1124428081
Provider Name (Legal Business Name): CANCER/BLOOD AND MEDICINE CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2014
Last Update Date: 03/13/2025
Certification Date: 03/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4050 NORTHRISE DR
LAS CRUCES NM
88011
US

IV. Provider business mailing address

4050 NORTHRISE DR
LAS CRUCES NM
88011
US

V. Phone/Fax

Practice location:
  • Phone: 575-652-3040
  • Fax:
Mailing address:
  • Phone: 575-652-3040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QX0200X
TaxonomyOncology Clinic/Center
License Number4937678
License Number StateNM
# 4
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IKENNA OSUORJI
Title or Position: MEDICAL DIRECTOR/CEO
Credential: MD,FACP
Phone: 832-859-0100