MEDICARE: RIO GRANDE MEDICAL GROUP, LTD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207KA0200X	Allergy Physician
2	207RI0200X	Infectious Disease Physician
3	208000000X	Pediatrics Physician
4	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013900794
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RIO GRANDE MEDICAL GROUP, LTD

Provider Business Mailing Address
First Line	:	4371 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-532-8900
Fax Number	:	575-532-8910

Provider Business Practice Location Address
First Line	:	4371 E LOHMAN AVE
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-532-8900
Fax Number	:	575-532-8910

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	DR. HASAN ADNAN
Credential	:	M.D.
Telephone Number	:	575-532-8900

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	11/13/2013

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Directions to “RIO GRANDE MEDICAL GROUP, LTD ” Practice Location

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