Healthcare Provider Details

I. General information

NPI: 1629714498
Provider Name (Legal Business Name): IRWIN MEDICAL SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2022
Last Update Date: 06/02/2022
Certification Date: 05/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 N TELSHOR BLVD STE A-1
LAS CRUCES NM
88011-8243
US

IV. Provider business mailing address

530 N TELSHOR BLVD STE A-1
LAS CRUCES NM
88011-8243
US

V. Phone/Fax

Practice location:
  • Phone: 575-636-1570
  • Fax: 877-636-1570
Mailing address:
  • Phone: 575-636-1570
  • Fax: 877-636-1570

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DANIEL IRWIN
Title or Position: OWNER/MANAGER
Credential:
Phone: 575-636-1570