# BACK AND NECK MEDICAL CARE CENTER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1417530304
- **Authorized official:** DR. GLENN J. WALDT DO (PROVIDER OWNER)
- **Authorized official phone:** (505) 695-1227

## Contact information

- **Practice address:** 2803 DORAL CT, LAS CRUCES, NM 88011-8616
- **Practice address phone:** (046) 984-4063
- **Practice address fax:** (877) 532-2113
- **Mailing address:** 1180 COMMERCE DR UNIT 14222, LAS CRUCES, NM 88013-4649
- **Mailing address phone:** (505) 695-1227
- **Mailing address fax:** (877) 532-2113

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM2500X | Medical Specialty Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 04/29/2021
- **Last updated:** 05/08/2024