Healthcare Provider Details

I. General information

NPI: 1609822931
Provider Name (Legal Business Name): LAS CRUCES MEDICAL CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 02/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4311 E LOHMAN AVE
LAS CRUCES NM
88011-8255
US

IV. Provider business mailing address

PO BOX 847563
DALLAS TX
75284
US

V. Phone/Fax

Practice location:
  • Phone: 505-556-7610
  • Fax: 505-556-7619
Mailing address:
  • Phone: 505-556-7610
  • Fax: 505-556-7619

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number3091
License Number StateNM

VIII. Authorized Official

Name: PAULA LALOR
Title or Position: DIRECTOR/DELEGATED OFFICIAL
Credential:
Phone: 615-925-4565