Provider Demographics
NPI:1881974194
Name:TELSHOR FAMILY CLINIC LLC
Entity type:Organization
Organization Name:TELSHOR FAMILY CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:KANAKA LAKSHMY
Authorized Official - Middle Name:
Authorized Official - Last Name:CHELLAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-652-4048
Mailing Address - Street 1:4500 N SONOMA RANCH BLVD
Mailing Address - Street 2:
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-7334
Mailing Address - Country:US
Mailing Address - Phone:575-652-4048
Mailing Address - Fax:575-556-9766
Practice Address - Street 1:4500 N SONOMA RANCH BLVD
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-7334
Practice Address - Country:US
Practice Address - Phone:575-652-4048
Practice Address - Fax:575-556-9766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-18
Last Update Date:2024-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD20100227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMAAA1647Medicare PIN