Provider Demographics
NPI:1275660219
Name:GREEG FAMILY HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:GREEG FAMILY HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CMC
Authorized Official - Prefix:
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-5700
Mailing Address - Street 1:1557 MONTE VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5731
Mailing Address - Country:US
Mailing Address - Phone:575-532-5700
Mailing Address - Fax:575-532-5733
Practice Address - Street 1:1557 MONTE VISTA AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5731
Practice Address - Country:US
Practice Address - Phone:575-532-5700
Practice Address - Fax:575-532-5733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2010-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM34789758Medicaid