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General NPI Number Information
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NPI Number | 1447245667
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Entity Type | Organization
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Legal Business Name | MIMBRES PROFESSIONAL ANESTHESIA SERVICE
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Dates
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Enumeration Date | 09/14/2005
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1313 E 32ND ST
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City | SILVER CITY
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State | NM
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Zip | 88061-7251
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Country | US
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Telephone | 505-538-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 2311 RANCH CLUB RD
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City | SILVER CITY
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State | NM
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Zip | 88061-7807
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Country | US
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Telephone | 505-388-4782
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MS. ALISON K GARNER
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Credential | CRNA
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Telephone | 505-388-4782
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State | NM
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