Provider Demographics
NPI:1265475933
Name:MESILLA VALLEY ANESTHESIOLOGY PC
Entity Type:Organization
Organization Name:MESILLA VALLEY ANESTHESIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:S
Authorized Official - Last Name:MCCOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-7000
Mailing Address - Street 1:205 W. BOUTZ RD.
Mailing Address - Street 2:BLDG #1
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:
Practice Address - Street 1:205 W. BOUTZ RD.
Practice Address - Street 2:BLDG #1
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005
Practice Address - Country:US
Practice Address - Phone:575-532-7000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CI7030OtherRR MEDICARE
NMK0756Medicaid
CI7030OtherRR MEDICARE