Provider Demographics
NPI:1700821808
Name:PHC-LAS CRUCES INC
Entity Type:Organization
Organization Name:PHC-LAS CRUCES INC
Other - Org Name:MEMORIAL MEDICAL CENTER OF LAS CRUCES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:LAWRENCE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:156-920-7000
Mailing Address - Street 1:330 SEVEN SPRINGS WAY
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-5098
Mailing Address - Country:US
Mailing Address - Phone:615-920-7000
Mailing Address - Fax:615-920-8913
Practice Address - Street 1:2450 S TELSHOR BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-5069
Practice Address - Country:US
Practice Address - Phone:575-522-8641
Practice Address - Fax:575-521-5013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-20
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3171282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM67939864Medicaid
NM201060533OtherPRESBYTERIAN SALUD
NMNM0096OtherBLUE CROSS BLUE SHIELD
NM201060533OtherPRESBYTERIAN HEALTH
NMPROVFP9019OtherMOLINA SALUD
NM201060533OtherPRESBYTERIAN SALUD