Organization
NEW MEXICO PHS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THERESA NICHOLAS (CREDENTIALING MANAGER)
(901) 261-4858
Entity
Organization
Contact information
Practice address
9155 CRESTWYN HILLS DR, MEMPHIS, TN 38125-8501
(901) 261-4848
(901) 261-4849
Mailing address
6565 AMERICAS PKWY NE STE 200, ALBUQUERQUE, NM 87110-8172
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
10/05/2010
Last updated
10/05/2010
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