Provider Demographics
NPI:1174535066
Name:LAS CRUCES MEDICAL SUPPLY
Entity type:Organization
Organization Name:LAS CRUCES MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEANN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAJAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-541-0007
Mailing Address - Street 1:2293 DIVOT AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-8416
Mailing Address - Country:US
Mailing Address - Phone:505-541-0007
Mailing Address - Fax:505-541-0027
Practice Address - Street 1:2293 DIVOT AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-8416
Practice Address - Country:US
Practice Address - Phone:505-541-0007
Practice Address - Fax:505-541-0027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00NM00T29FOtherBLUE CROSS/BLUE SHIELD
NM78137Medicaid
NM4250370001Medicare ID - Type Unspecified