Provider Demographics
NPI:1073790978
Name:FESSS FAMILY HEALTHCARE LLC
Entity Type:Organization
Organization Name:FESSS FAMILY HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:K
Authorized Official - Last Name:ATTIOGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-522-4145
Mailing Address - Street 1:2020 S SOLANO DR
Mailing Address - Street 2:SUITE # B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5416
Mailing Address - Country:US
Mailing Address - Phone:575-522-4145
Mailing Address - Fax:575-522-5236
Practice Address - Street 1:2020 S SOLANO DR
Practice Address - Street 2:SUITE # B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5416
Practice Address - Country:US
Practice Address - Phone:575-522-4145
Practice Address - Fax:575-522-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-23
Last Update Date:2009-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99-159302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM58952535Medicaid
NM900521555Medicare PIN
NM349805101Medicare PIN
NMH66715Medicare UPIN