Provider Demographics
NPI:1518175397
Name:MESILLA VALLEY WOMEN'S HEALTH, PA
Entity Type:Organization
Organization Name:MESILLA VALLEY WOMEN'S HEALTH, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-526-5209
Mailing Address - Street 1:419 BASON DR
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3717
Mailing Address - Country:US
Mailing Address - Phone:505-526-5209
Mailing Address - Fax:505-524-7135
Practice Address - Street 1:419 BASON DR
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3717
Practice Address - Country:US
Practice Address - Phone:505-526-5209
Practice Address - Fax:505-524-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM7959207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00019216Medicaid
NM00019216Medicaid