Provider Demographics
NPI:1891076519
Name:AGAPE PAIN MANAGEMENT AND ANESTHESIA, LLC
Entity Type:Organization
Organization Name:AGAPE PAIN MANAGEMENT AND ANESTHESIA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LLEWELYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-449-7002
Mailing Address - Street 1:2170 E LOHMAN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8411
Mailing Address - Country:US
Mailing Address - Phone:575-449-7002
Mailing Address - Fax:575-652-4684
Practice Address - Street 1:2170 E LOHMAN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8411
Practice Address - Country:US
Practice Address - Phone:575-449-7002
Practice Address - Fax:575-652-4684
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-08
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2010-0116207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM25575244Medicaid