MEDICARE: LUNG & SLEEP ASSOCIATES OF LAS CRUCES LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207RC0200X	Critical Care Medicine (Internal Medicine) Physician
2	207R00000X	Internal Medicine Physician
3	207RP1001X	Pulmonary Disease Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM007H49	OTHER	NM	BCBS OF NM
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295728301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LUNG & SLEEP ASSOCIATES OF LAS CRUCES LLC

Provider Business Mailing Address
First Line	:	205 W BOUTZ RD
Second Line	:	BLDG 1
City	:	LAS CRUCES
State	:	NM
Zip	:	88005-3262
Country	:	US
Telephone Number	:	575-532-7000
Fax Number	:	575-556-7131

Provider Business Practice Location Address
First Line	:	2735 NORTHRISE DR
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-0897
Country	:	US
Telephone Number	:	575-532-4344
Fax Number	:	575-532-4347

Authorized Official
Title or Position	:	OWNER
Name	:	JAMES P BRADLEY
Credential	:	MD
Telephone Number	:	575-532-4344

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	07/01/2009

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