Provider Demographics
NPI:1497069397
Name:PHC LAS CRUCES INC.
Entity Type:Organization
Organization Name:PHC LAS CRUCES INC.
Other - Org Name:MEMORIAL MEDICAL CENTER-IKARD CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGEMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:WELLBORN
Authorized Official - Suffix:
Authorized Official - Credentials:MHA, CPC-A, CEMC
Authorized Official - Phone:575-521-5460
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:575-556-5960
Mailing Address - Fax:575-556-5959
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:STE E
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5069
Practice Address - Country:US
Practice Address - Phone:575-556-5800
Practice Address - Fax:575-556-5899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-03
Last Update Date:2016-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty