Provider Demographics
NPI:1699883132
Name:NEW MEXICO CARDIAC CARE
Entity type:Organization
Organization Name:NEW MEXICO CARDIAC CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ESTELLA
Authorized Official - Middle Name:M
Authorized Official - Last Name:CANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-521-3270
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:505-521-3270
Mailing Address - Fax:505-521-3504
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:505-521-3270
Practice Address - Fax:505-521-3504
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NEW MEXICO CARDIAC CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM700521019Medicare PIN