Provider Demographics
NPI:1477581031
Name:ALAMOGORDO INTERNAL MEDICINE P.C.
Entity type:Organization
Organization Name:ALAMOGORDO INTERNAL MEDICINE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GIRIDHAR
Authorized Official - Middle Name:REDDY
Authorized Official - Last Name:ANIREDDY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-434-2965
Mailing Address - Street 1:2751 SCENIC DR
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8726
Mailing Address - Country:US
Mailing Address - Phone:575-434-2965
Mailing Address - Fax:575-439-8254
Practice Address - Street 1:2751 SCENIC DR
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8726
Practice Address - Country:US
Practice Address - Phone:575-434-2965
Practice Address - Fax:575-439-8254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM20020255261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM62281305Medicaid
NMG82403Medicare UPIN
NM62281305Medicaid