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Organization

GABA LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
JOHN A. MOORE CRNA (PRESIDENT)
(575) 532-7000
Entity
Organization

Contact information

Practice address
1313 E 32ND ST, SILVER CITY, NM 88061-7251
(575) 538-4000
Mailing address
205 W BOUTZ RD BLDG 1, LAS CRUCES, NM 88005-3259
(575) 532-7000

Taxonomy

Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
10425535
NM
01
DF2100
RR MEDICARE
Enumeration date
08/23/2006
Last updated
06/30/2009
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