Healthcare Provider Details

I. General information

NPI: 1700345436
Provider Name (Legal Business Name): LANCER HEALTH GROUP, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2019
Last Update Date: 04/01/2021
Certification Date: 04/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S 2ND ST
RATON NM
87740-2102
US

IV. Provider business mailing address

PO BOX 8
RATON NM
87740-0008
US

V. Phone/Fax

Practice location:
  • Phone: 505-400-5491
  • Fax:
Mailing address:
  • Phone: 505-400-5491
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARCIA HEFKER
Title or Position: OWNER/PRACTITIONER
Credential: FNP-BC
Phone: 505-398-1567