Provider Demographics
NPI:1235484304
Name:LAS CRUCES PHYSICIAN PRACTICES LLC
Entity Type:Organization
Organization Name:LAS CRUCES PHYSICIAN PRACTICES LLC
Other - Org Name:WOMENS MEDICAL ASSOCAITES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOWMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-920-7000
Mailing Address - Street 1:PO BOX 6310
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88006-6310
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2100 S TRIVIZ DR
Practice Address - Street 2:SUITE H
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-0605
Practice Address - Country:US
Practice Address - Phone:575-522-9793
Practice Address - Fax:575-532-9019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-16
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM900522525Medicare PIN