MEDICARE: LAS CRUCES SURGICAL ASSOCIATES PA

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	208600000X	Surgery Physician	2004-0619	NM

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	:	1669520987
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAS CRUCES SURGICAL ASSOCIATES PA

Provider Business Mailing Address
First Line	:	PO BOX 16544
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88004-6544
Country	:	US
Telephone Number	:	505-522-1931
Fax Number	:	505-532-1665

Provider Business Practice Location Address
First Line	:	2803 DORAL CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8616
Country	:	US
Telephone Number	:	505-522-1931
Fax Number	:	505-532-1665

Authorized Official
Title or Position	:	OWNER
Name	:	KAMRAN KAMALI
Credential	:	MD
Telephone Number	:	505-522-1931

Provider Enumeration Date	:	01/05/2007
Last Update Date	:	05/01/2009

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