Provider Demographics
NPI:1528201597
Name:NEW MEXICO PRIMARY CARE GROUP P.C.
Entity Type:Organization
Organization Name:NEW MEXICO PRIMARY CARE GROUP P.C.
Other - Org Name:SANGEETH SHANBHAG MD PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SANGEETH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANBHAG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-521-8500
Mailing Address - Street 1:179 HOWARD PL
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8157
Mailing Address - Country:US
Mailing Address - Phone:575-521-8500
Mailing Address - Fax:575-521-8400
Practice Address - Street 1:179 HOWARD PL
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8157
Practice Address - Country:US
Practice Address - Phone:575-521-8500
Practice Address - Fax:575-521-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-07
Last Update Date:2023-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMB2250Medicare PIN