Provider Demographics
NPI:1912900259
Name:ALLERGY & ASTHMA CENTER OF THE SOUTHWEST
Entity type:Organization
Organization Name:ALLERGY & ASTHMA CENTER OF THE SOUTHWEST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STANISLAUS
Authorized Official - Middle Name:
Authorized Official - Last Name:TING
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:505-522-2400
Mailing Address - Street 1:1141 MALL DR
Mailing Address - Street 2:STE A-B
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8194
Mailing Address - Country:US
Mailing Address - Phone:575-522-2400
Mailing Address - Fax:575-522-2375
Practice Address - Street 1:1141 MALL DR
Practice Address - Street 2:STE B
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8194
Practice Address - Country:US
Practice Address - Phone:575-522-2400
Practice Address - Fax:575-522-2375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-05-31
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM83-322207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM32219Medicaid
NM2-13487-1Medicare ID - Type UnspecifiedMEDICARE
NMD36000Medicare UPIN