MEDICARE: INTEGRATIVE MEDICAL CENTER OF NEW MEXICO,PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	79-9	NM

General Provider Information

NPI Number	:	1346319076
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTEGRATIVE MEDICAL CENTER OF NEW MEXICO,PC

Provider Business Mailing Address
First Line	:	1155 COMMERCE DR STE C
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8257
Country	:	US
Telephone Number	:	575-524-3720
Fax Number	:	575-524-3721

Provider Business Practice Location Address
First Line	:	1155 COMMERCE DR STE C
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8257
Country	:	US
Telephone Number	:	575-524-3720
Fax Number	:	575-524-3721

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	ANN BERKSON
Credential	:
Telephone Number	:	575-524-3720

Provider Enumeration Date	:	11/07/2006
Last Update Date	:	02/17/2011

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