MEDICARE: EDWARD CALLAHAN

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	251B00000X	Case Management Agency
2	172V00000X	Community Health Worker

General Provider Information

NPI Number	:	1699564005
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD CALLAHAN

Provider Business Mailing Address
First Line	:	10015 ROBERT LARSON
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-9005
Country	:	US
Telephone Number	:	575-640-7455
Fax Number	:

Provider Business Practice Location Address
First Line	:	10015 ROBERT LARSON
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007-9005
Country	:	US
Telephone Number	:	575-640-7455
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2025
Last Update Date	:	07/17/2025

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Directions to “ EDWARD CALLAHAN ” Practice Location

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