Provider Demographics
NPI:1114996188
Name:ISIS MEDICINE PC
Entity Type:Organization
Organization Name:ISIS MEDICINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRTIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:ANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-983-8387
Mailing Address - Street 1:401 BOTULPH LN
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-6912
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:401 BOTULPH LN
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-6912
Practice Address - Country:US
Practice Address - Phone:505-983-8387
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2005-0046363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty