Provider Demographics
NPI:1437373370
Name:DR AEMON R TECHEIRA LLC
Entity Type:Organization
Organization Name:DR AEMON R TECHEIRA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AEMON
Authorized Official - Middle Name:R
Authorized Official - Last Name:TECHEIRA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-7000
Mailing Address - Street 1:PO BOX 787
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88241-0787
Mailing Address - Country:US
Mailing Address - Phone:575-532-7000
Mailing Address - Fax:
Practice Address - Street 1:5419 N. LOVINGTON HWY
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9131
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:2007-04-12
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM009947OtherBCBS
DB3423OtherRR MEDICARE
TX151741901Medicaid
NM64339823Medicaid
DB3423OtherRR MEDICARE