Provider Demographics
NPI:1699964460
Name:AMY O'NEILL D.O.M, LLC
Entity type:Organization
Organization Name:AMY O'NEILL D.O.M, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:AMY
Authorized Official - Middle Name:NICHOLS
Authorized Official - Last Name:O'NEILL
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-527-0821
Mailing Address - Street 1:275 BLUE SKY LN
Mailing Address - Street 2:
Mailing Address - City:MESILLA PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88047-9751
Mailing Address - Country:US
Mailing Address - Phone:505-527-0821
Mailing Address - Fax:505-524-2059
Practice Address - Street 1:200 W LAS CRUCES AVE
Practice Address - Street 2:
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88005-1803
Practice Address - Country:US
Practice Address - Phone:505-496-8161
Practice Address - Fax:505-524-2059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNMOORJ29OtherBCBS
NMZZ171100000XOtherPRES