Healthcare Provider Details

I. General information

NPI: 1851301857
Provider Name (Legal Business Name): LAS CRUCES SCHOOL DISTRICT NO. 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 11/05/2020
Certification Date: 11/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 S MAIN ST STE 249
LAS CRUCES NM
88001-1243
US

IV. Provider business mailing address

505 S MAIN ST SUITE 249
LAS CRUCES NM
88001-1206
US

V. Phone/Fax

Practice location:
  • Phone: 575-527-5823
  • Fax: 505-527-5886
Mailing address:
  • Phone: 505-527-5884
  • Fax: 505-527-5886

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code251300000X
TaxonomyLocal Education Agency (LEA)
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH J TINGUELY
Title or Position: MEDICAID SCHOOL BASED SERVICES COOR
Credential: R.N.
Phone: 575-527-5823