# NEW MEXICO PHS LLC

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

## Provider details

- **NPI number:** 1871802082
- **Authorized official:** THERESA NICHOLAS (CREDENTIALING MANAGER)
- **Authorized official phone:** (901) 261-4858

## Contact information

- **Practice address:** 9155 CRESTWYN HILLS DR, MEMPHIS, TN 38125-8501
- **Practice address phone:** (901) 261-4848
- **Practice address fax:** (901) 261-4849
- **Mailing address:** 6565 AMERICAS PKWY NE STE 200, ALBUQUERQUE, NM 87110-8172

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |

## Other

- **Enumeration date:** 10/05/2010
- **Last updated:** 10/05/2010