Healthcare Provider Details

I. General information

NPI: 1770699936
Provider Name (Legal Business Name): MECA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2006
Last Update Date: 08/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1350 HILLRISE CIRCLE
LAS CRUCES NM
88001
US

IV. Provider business mailing address

780 S WALNUT ST BLDG #7
LAS CRUCES NM
88001-1425
US

V. Phone/Fax

Practice location:
  • Phone: 505-526-1161
  • Fax: 505-523-1108
Mailing address:
  • Phone: 505-526-1161
  • Fax: 505-523-1108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. MATT S. GALLEGOS
Title or Position: DIRECTOR OF PERSONNEL
Credential:
Phone: 505-526-1161