Organization
MMC CANCER CENTER
Active
Parent organization
MEMORIAL MEDICAL CENTER
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEMORIAL MEDICAL CENTER
Authorized official
MR. PAUL HERZOG (CEO)
(575) 521-2258
Entity
Organization
Contact information
Practice address
2530 S TELSHOR BLVD STE 201, LAS CRUCES, NM 88011-4975
(575) 521-1554
(575) 556-1754
Mailing address
2530 S TELSHOR BLVD STE 201, LAS CRUCES, NM 88011-4975
(575) 521-1554
(575) 556-1754
Taxonomy
Speciality
Code
Description
License number
State
273R00000X
Psychiatric Hospital Unit
Primary
0110081
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LPCC 0110081
NEW MEXICO LICENSE FROM THE COUNSELING AND THERAPY PRACTICE BOARD
—
Enumeration date
06/27/2012
Last updated
06/27/2012
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