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1447245667

NPI Code Detail

MEDICARE: MIMBRES PROFESSIONAL ANESTHESIA SERVICE

MEDICARE: MIMBRES PROFESSIONAL ANESTHESIA SERVICE

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	367500000X	Certified Registered Nurse Anesthetist		NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	DB8211	OTHER	NM	RAILROAD MEDICARE - GROUP

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
2	NM006792	OTHER	NM	BCBS NM
4	200513200	OTHER	NM	DEPT OF LABOR W/COMP

General Provider Information

NPI Number	:	1447245667
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MIMBRES PROFESSIONAL ANESTHESIA SERVICE

Provider Business Mailing Address
First Line	:	2311 RANCH CLUB RD
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7807
Country	:	US
Telephone Number	:	505-388-4782
Fax Number	:

Provider Business Practice Location Address
First Line	:	1313 E 32ND ST
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-7251
Country	:	US
Telephone Number	:	505-538-4000
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. ALISON K GARNER
Credential	:	CRNA
Telephone Number	:	505-388-4782

Provider Enumeration Date	:	09/14/2005
Last Update Date	:	07/21/2022

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Directions to “MIMBRES PROFESSIONAL ANESTHESIA SERVICE ” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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