Provider Demographics
NPI:1881881902
Name:NEW MEXICO COMMUNITY PSYCHIATRY, PC
Entity type:Organization
Organization Name:NEW MEXICO COMMUNITY PSYCHIATRY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ORTIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-799-1412
Mailing Address - Street 1:1916 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-4026
Mailing Address - Country:US
Mailing Address - Phone:575-799-1412
Mailing Address - Fax:575-935-2122
Practice Address - Street 1:1916 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-4026
Practice Address - Country:US
Practice Address - Phone:575-935-2121
Practice Address - Fax:575-935-2122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-02
Last Update Date:2013-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMMD2007-06532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2885408OtherNEW MEXICO REGISTRATION N