Organization
SOUTHERN NEW MEXICO NEUROSURGERY LLC
Active
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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