Organization
SOUTHERN NEW MEXICO NEUROSURGERY LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRETT R. HENDERSON M.D. (PRESIDENT)
(575) 522-1974
Entity
Organization
Contact information
Practice address
3850 E LOHMAN AVE STE C, LAS CRUCES, NM 88011-8288
(575) 522-1974
(575) 522-5209
Mailing address
PO BOX 13668, LAS CRUCES, NM 88013-3668
(575) 522-1974
(575) 522-5209
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
21709751
—
NM
01
—
DG08655
RR MEDICARE
—
01
—
NM007L05
BCBS OF NM
NM
Enumeration date
10/01/2007
Last updated
06/26/2015
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