Healthcare Provider Details

I. General information

NPI: 1003827650
Provider Name (Legal Business Name): PREMIER CARE LAS CRUCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/10/2006
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

STEFAN C SCHAEFER MD 2465 S TELSHOR BLVD
LAS CRUCES NM
88011
US

IV. Provider business mailing address

PO BOX 220
SULLIVAN MO
63080-0220
US

V. Phone/Fax

Practice location:
  • Phone: 505-556-0101
  • Fax: 505-522-0808
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberCL00010409
License Number StateNM

VIII. Authorized Official

Name: CHARLES FEESE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 573-860-2273