Healthcare Provider Details

I. General information

NPI: 1003932773
Provider Name (Legal Business Name): RIO GRANDE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE SUITE 301
LAS CRUCES NM
88011-8259
US

IV. Provider business mailing address

4351 E LOHMAN AVE SUITE 301
LAS CRUCES NM
88011-8259
US

V. Phone/Fax

Practice location:
  • Phone: 505-532-8900
  • Fax: 505-532-8974
Mailing address:
  • Phone: 505-532-8900
  • Fax: 505-532-8974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number State

VIII. Authorized Official

Name: DR. HASAN ADNAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 505-532-8900