Healthcare Provider Details

I. General information

NPI: 1528112109
Provider Name (Legal Business Name): LC-ENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 05/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1130 COMMERCE DR
LAS CRUCES NM
88011-8209
US

IV. Provider business mailing address

1130 COMMERCE DR
LAS CRUCES NM
88011-8209
US

V. Phone/Fax

Practice location:
  • Phone: 575-521-3025
  • Fax:
Mailing address:
  • Phone: 575-521-3025
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number2470
License Number StateNM

VIII. Authorized Official

Name: TERRY H MCMILLAN
Title or Position: OWNER
Credential:
Phone: 575-521-3025