Organization
ALTEON HEALTH NEW MEXICO LLC
Active
Other names
Island Medical LOE LLC, Pegasus Emergency Group LOE LLC
Organization subpart
No
Provider details
NPI number
Authorized official
MELISSA REESE (PROVIDER ENROLLMENT OFFICER)
(855) 687-0618
Entity
Organization
Contact information
Practice address
5419 N LOVINGTON HWY, HOBBS, NM 88240-9100
(844) 474-4019
Mailing address
4535 DRESSLER RD NW, CANTON, OH 44718-2545
(330) 994-4409
(330) 492-8489
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
58674853
—
NM
Enumeration date
10/19/2011
Last updated
02/24/2023
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