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General NPI Number Information
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NPI Number | 1811753767
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Entity Type | Organization
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Legal Business Name | TMS NEW MEXICO LLC
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Dates
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Enumeration Date | 02/27/2024
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Last Update Date | 02/27/2024
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Provider Practice Location Address
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Address Line | 300 PASEO DE PERALTA STE 208
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City | SANTA FE
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State | NM
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Zip | 87501-5509
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Country | US
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Telephone | 505-505-6566
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Fax | 505-505-6566
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Provider Business Mailing Address
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Address Line | 300 PASEO DE PERALTA STE 208
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City | SANTA FE
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State | NM
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Zip | 87501-5509
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Country | US
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Telephone | 505-505-6566
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | KIMBERLY MERCILLE
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Credential | RN
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Telephone | 314-226-1997
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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