Provider Demographics
NPI:1912039413
Name:DRS. ANDREWS AND JOHNSON OF THE MESILLA VALLEY
Entity Type:Organization
Organization Name:DRS. ANDREWS AND JOHNSON OF THE MESILLA VALLEY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-526-5525
Mailing Address - Street 1:225 E IDAHO AVE
Mailing Address - Street 2:#17
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88005-3257
Mailing Address - Country:US
Mailing Address - Phone:575-526-5525
Mailing Address - Fax:575-541-0498
Practice Address - Street 1:225 E IDAHO AVE
Practice Address - Street 2:#17
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-3257
Practice Address - Country:US
Practice Address - Phone:575-526-5525
Practice Address - Fax:575-541-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-10
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM85-3207R00000X
NM77-190207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB9667Medicaid
NMNM009528OtherBLUE CROSS BLUE SHIELD
NM400521082Medicare ID - Type UnspecifiedMEDICARE GROUP