Provider Demographics
NPI:1447245667
Name:MIMBRES PROFESSIONAL ANESTHESIA SERVICE
Entity Type:Organization
Organization Name:MIMBRES PROFESSIONAL ANESTHESIA SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ALISON
Authorized Official - Middle Name:K
Authorized Official - Last Name:GARNER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:505-388-4782
Mailing Address - Street 1:2311 RANCH CLUB RD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7807
Mailing Address - Country:US
Mailing Address - Phone:505-388-4782
Mailing Address - Fax:
Practice Address - Street 1:1313 E 32ND ST
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-7251
Practice Address - Country:US
Practice Address - Phone:505-538-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM48402516Medicaid
NMNM006792OtherBCBS NM
NMDB8211OtherRAILROAD MEDICARE - GROUP
NM200513200OtherDEPT OF LABOR W/COMP
NM200513200OtherDEPT OF LABOR W/COMP
NMDB8211OtherRAILROAD MEDICARE - GROUP