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NPI Code Detail

MEDICARE: NEW MEXICO PHS LLC

MEDICARE: NEW MEXICO PHS LLC
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
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1871802082
Entity Type Code : Organization
Provider Name (Legal Business Name) : NEW MEXICO PHS LLC
Provider Business Mailing Address
First Line : 6565 AMERICAS PKWY NE STE 200
Second Line :
City : ALBUQUERQUE
State : NM
Zip : 87110-8172
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 9155 CRESTWYN HILLS DR
Second Line :
City : MEMPHIS
State : TN
Zip : 38125-8501
Country : US
Telephone Number : 901-261-4848
Fax Number : 901-261-4849
Authorized Official
Title or Position : CREDENTIALING MANAGER
Name : THERESA NICHOLAS
Credential :
Telephone Number : 901-261-4858
Provider Enumeration Date : 10/05/2010
Last Update Date : 10/05/2010

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Directions to “NEW MEXICO PHS LLC ” Practice Location

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