Provider Demographics
NPI:1912367434
Name:FESSS FAMILY HEATHCARE
Entity Type:Organization
Organization Name:FESSS FAMILY HEATHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:FRANCIS
Authorized Official - Middle Name:KWASHIE
Authorized Official - Last Name:ATTIOGBE
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP,
Authorized Official - Phone:575-522-4145
Mailing Address - Street 1:3039 MEMORIAL CT
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-9127
Mailing Address - Country:US
Mailing Address - Phone:575-522-4145
Mailing Address - Fax:575-522-5236
Practice Address - Street 1:3039 MEMORIAL CT
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-9127
Practice Address - Country:US
Practice Address - Phone:575-522-4145
Practice Address - Fax:575-522-5236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-25
Last Update Date:2016-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02859261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care