Provider Demographics
NPI:1164613261
Name:ANN S MERCER MD PA
Entity Type:Organization
Organization Name:ANN S MERCER MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANN
Authorized Official - Middle Name:SHUKRI
Authorized Official - Last Name:MERCER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-522-6900
Mailing Address - Street 1:2801 MISSOURI AVE STE 12
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-5061
Mailing Address - Country:US
Mailing Address - Phone:505-522-6900
Mailing Address - Fax:505-522-8891
Practice Address - Street 1:2801 MISSOURI AVE STE 12
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5061
Practice Address - Country:US
Practice Address - Phone:505-522-6900
Practice Address - Fax:505-522-8891
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM84-79207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM33407Medicaid
NMD08431Medicare UPIN
NM33407Medicaid