Provider Demographics
NPI:1356514525
Name:BEN HILL PASSMORE MD PA
Entity type:Organization
Organization Name:BEN HILL PASSMORE MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BEN
Authorized Official - Middle Name:HILL
Authorized Official - Last Name:PASSMORE
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:575-937-3377
Mailing Address - Street 1:126 DIPAOLO DR
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345
Mailing Address - Country:US
Mailing Address - Phone:575-937-3377
Mailing Address - Fax:575-630-2083
Practice Address - Street 1:208 PORR DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345
Practice Address - Country:US
Practice Address - Phone:575-937-3377
Practice Address - Fax:575-630-2083
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-09
Last Update Date:2008-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNM99982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ6302Medicaid
NMQ6302Medicaid