Provider Demographics
NPI:1164827127
Name:PHC LAS CRUCES, INC
Entity Type:Organization
Organization Name:PHC LAS CRUCES, INC
Other - Org Name:MMC FAMILY MEDICINE CENTER ECHO CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:MCGONNELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-521-5295
Mailing Address - Street 1:PO BOX 6159
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88006-6159
Mailing Address - Country:US
Mailing Address - Phone:575-521-5370
Mailing Address - Fax:575-521-5376
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5069
Practice Address - Country:US
Practice Address - Phone:575-521-5370
Practice Address - Fax:575-521-5376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-03
Last Update Date:2014-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty