Provider Demographics
NPI:1497707442
Name:MESILLA VALLEY HEALTHCARE ASSOCIATES P.A.
Entity type:Organization
Organization Name:MESILLA VALLEY HEALTHCARE ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELINA
Authorized Official - Middle Name:P
Authorized Official - Last Name:CARVER
Authorized Official - Suffix:
Authorized Official - Credentials:CNP
Authorized Official - Phone:505-523-4880
Mailing Address - Street 1:2020 S. SOLANO DR.
Mailing Address - Street 2:SUITE C
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88001-5416
Mailing Address - Country:US
Mailing Address - Phone:505-523-4880
Mailing Address - Fax:505-523-1796
Practice Address - Street 1:2020 S. SOLANO DR.
Practice Address - Street 2:SUITE C
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88001-5416
Practice Address - Country:US
Practice Address - Phone:505-523-4880
Practice Address - Fax:505-523-1796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMR19996363LF0000X
NMRII668363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
10004431OtherALL LOVELACE
NMNM006312OtherBCBS
NM95966Medicaid
PROVP11869OtherMOLINA
NM95966Medicaid
=========Medicare ID - Type Unspecified
S67309Medicare UPIN