Provider Demographics
NPI:1821189101
Name:BHASKER MEDICAL CLINIC PC
Entity Type:Organization
Organization Name:BHASKER MEDICAL CLINIC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BHASKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-835-2940
Mailing Address - Street 1:200 NEEL AVE
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-4649
Mailing Address - Country:US
Mailing Address - Phone:575-835-2940
Mailing Address - Fax:575-835-2216
Practice Address - Street 1:200 NEEL AVE
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4649
Practice Address - Country:US
Practice Address - Phone:575-835-2940
Practice Address - Fax:575-835-2216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2015-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44073Medicaid
NM201051377OtherPREJB
NM201051377OtherPREJB
NM2371968Medicare UPIN
NM2371968Medicare ID - Type Unspecified