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855 Anthony Dr Anthony NM 88021-9325 | |
(575) 882-5706 | |
(575) 882-2909 |
Full Name | |
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Speciality | Clinic/Center |
Location | 855 Anthony Dr, Anthony, New Mexico |
Authorized Official Name and Position | Virgil Medina (CHIEF EXECUTIVE OFFICER) |
Authorized Official Contact | 5755261105 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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385 Calle De Alegra Bldg. A Las Cruces NM 88005-3423 Ph: (575) 526-1105 | 855 Anthony Dr Anthony NM 88021-9325 Ph: (575) 882-5706 |
NPI Number | 1699748921 |
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Provider Enumeration Date | 02/08/2006 |
Last Update Date | 01/28/2020 |
Medicare PECOS PAC ID | 6305745191 |
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Medicare Enrollment ID | O20100803001131 |
Identifier | Type | State | Issuer |
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1699748921 | NPI | - | NPPES |
48025 | Medicaid | NM |