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General NPI Number Information
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NPI Number | 1124428081
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Entity Type | Organization
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Legal Business Name | CANCER/BLOOD AND MEDICINE CLINIC LLC
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Dates
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Enumeration Date | 08/28/2014
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Last Update Date | 03/13/2025
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Provider Practice Location Address
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Address Line | 4050 NORTHRISE DR
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City | LAS CRUCES
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State | NM
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Zip | 88011
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Country | US
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Telephone | 575-652-3040
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 NORTHRISE DR
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City | LAS CRUCES
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State | NM
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Zip | 88011
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Country | US
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Telephone | 575-652-3040
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR/CEO
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Name | DR. IKENNA OSUORJI
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Credential | MD,FACP
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Telephone | 832-859-0100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207RR0500X
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Taxonomy Name | Rheumatology Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QX0200X
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Taxonomy Name | Oncology Clinic/Center
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License Number | 4937678
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License Number State | NM
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Taxonomy #4
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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