Provider Demographics
NPI:1821122672
Name:VICTOR A. NWACHUKU, M.D., PC
Entity Type:Organization
Organization Name:VICTOR A. NWACHUKU, M.D., PC
Other - Org Name:CASSIE HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUSTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNOZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-388-1561
Mailing Address - Street 1:1618 E PINE ST
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061-7155
Mailing Address - Country:US
Mailing Address - Phone:575-388-1561
Mailing Address - Fax:575-388-9952
Practice Address - Street 1:1618 EAST PINE STREET
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061-1260
Practice Address - Country:US
Practice Address - Phone:575-388-1561
Practice Address - Fax:575-388-9952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VX0000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyObstetricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000B5081Medicaid
=========OtherFEDERAL TAX ID #
=========OtherFEDERAL TAX ID #
H28164Medicare UPIN