Organization
NEW MEXICO BRAIN INSTITUTE, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN PAUL SIMMONS MD (PRESIDENT/PHYSICIAN)
(505) 434-0901
Entity
Organization
Contact information
Practice address
108 COTTONWOOD DR, ALAMOGORDO, NM 88310-8219
(575) 434-0901
(575) 437-1992
Mailing address
108 COTTONWOOD DR, ALAMOGORDO, NM 88310-8219
(575) 434-0901
(575) 437-1992
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
900521021
MEDICARE GROUP PTAN
NM
01
—
CH6196
RR MEDICARE
NM
Enumeration date
08/24/2005
Last updated
10/26/2016
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