# LAS CRUCES PHYSICIAN PRACTICES LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** MMC Physician Assistants
- **Organization subpart:** No

## Provider details

- **NPI number:** 1851574248
- **Authorized official:** ANGIE MANGUM (DIRECTOR PHYSICIAN SERVICES)
- **Authorized official phone:** (505) 521-5277

## Contact information

- **Practice address:** 2450 S TELSHOR BLVD, LAS CRUCES, NM 88011-5069
- **Practice address phone:** (505) 521-5277
- **Mailing address:** PO BOX 6310, LAS CRUCES, NM 88006-6310

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 363AS0400X | Surgical Physician Assistant | — | NULL | Yes |
| 363AS0400X | Surgical Physician Assistant | — | — | Yes |

## Other

- **Enumeration date:** 12/10/2007
- **Last updated:** 06/30/2008