OTERO COUNTY MEDICAL GROUP (NPI# 1528494747) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1528494747 |
| Entity Type | Organization |
| Organization Name | OTERO COUNTY MEDICAL GROUP |
| Other Organization Name | CHAMPION CANCER CENTER OF OTERO COUNTY |
| Practice Address |
2559 Medical Dr Suite G Alamogordo NM 88310-8703 |
| Mailing Address |
2689 Scenic Dr Alamogordo NM 88310-8700 |
| Practice Telephone | 5754378126 |
| Mailing Telephone | 5754341699 |
| Mailing Fax Number | 5754348871 |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2013-09-19 |
| Authorized Official Name | MR. ROBERT JAMES HECKERT (CEO) |
| Authorized Official Telephone | 5754437845 |
| Authorized Official Credential | FACHE |
| Is Organization Subpart | Y |
| Parent Organization Name | OTERO COUNTY MEDICAL GROUP |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0001X |
Radiology Specialization: Radiation Oncology |
Allopathic & Osteopathic Physicians | ||
| N | 364SM0705X |
Clinical Nurse Specialist Specialization: Medical-Surgical |
Physician Assistants & Advanced Practice Nursing Providers | ||
| Y | 207RX0202X |
Internal Medicine Specialization: Medical Oncology |
Allopathic & Osteopathic Physicians |
| Other Name | Type Code |
|---|---|
| Champion Cancer Center of Otero County | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558797746 | Otero County Medical Group | Obstetrics & Gynecology | 2050 Scenic Dr, Alamogordo, NM 88310-3880 | 2013-09-19 |
| 1376978577 | Otero County Medical Group | Psychologist | 2689 Scenic Dr, Alamogordo, NM 88310-8700 | 2013-09-06 |
| 1932535127 | Otero County Medical Group | Family Medicine | 1401 10th St, Alamogordo, NM 88310-5012 | 2013-09-19 |
| 1467888651 | Otero County Medical Group | Surgery | 1100 10th St, Alamogordo, NM 88310-6414 | 2013-09-19 |
| 1487080776 | Otero County Medical Group | Surgery | 1212 9th St, Suite A, Alamogordo, NM 88310-5842 | 2013-09-19 |
| 1639505829 | Otero County Medical Group | Nurse Practitioner | 2539 Medical Dr, Suite 107, Alamogordo, NM 88310-8720 | 2013-09-19 |
| 1831525120 | Otero County Medical Group | Internal Medicine | 2689 Scenic Dr, Alamogordo, NM 88310-8700 | 2013-09-19 |
| 1346676566 | Otero County Medical Group | Internal Medicine | 2689 Scenic Dr, Alamogordo, NM 88310-8700 | 2013-09-19 |
| 1275969495 | Otero County Medical Group | Family Medicine | 1101 9th St, Suite A, Alamogordo, NM 88310-6432 | 2013-09-19 |
| 1093141491 | Otero County Medical Group | Orthopaedic Surgery | 2539 Medical Dr, Suite 110, Alamogordo, NM 88310-8720 | 2013-09-18 |
| Street Address |
2559 MEDICAL DR SUITE G |
| City | ALAMOGORDO |
| State | NM |
| Zip Code | 88310-8703 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275531394 | Renee Yvette Friday | Pediatrics | 2559 Medical Dr, Ste A, Alamogordo, NM 88310-8704 | 2005-07-12 |
| 1578069860 | Marjorie Anne Grant | Pharmacy Technician | 2559 Medical Dr, Alamogordo, NM 88310-8703 | 2018-04-04 |
| 1437584059 | Otero County Medical Group | Obstetrics & Gynecology | 2559 Medical Dr, Suite D, Alamogordo, NM 88310-8703 | 2013-09-13 |
| 1538594155 | Otero County Medical Group | Pediatrics | 2559 Medical Dr, Suite A, Alamogordo, NM 88310-8703 | 2013-09-13 |
| 1952736183 | Otero County Medical Group | Internal Medicine | 2559 Medical Dr, Suite F, Alamogordo, NM 88310-8703 | 2013-09-06 |
| 1477882876 | Peter Bernat | Internal Medicine | 2559 Medical Dr, Suite G, Alamogordo, NM 88310-8703 | 2009-12-14 |
| 1255526216 | Sungho Jun Md PC Inc | Family Medicine | 2559 Medical Dr, Suite B, Alamogordo, NM 88310-8703 | 2007-09-12 |
| 1124233903 | Allan L. Paul M.d., PC | Pediatrics | 2559 Medical Dr, Ste E, Alamogordo, NM 88310-8703 | 2007-05-14 |
| 1063639409 | Norman D. Lindley | Obstetrics & Gynecology | 2559 Medical Dr, Suite D, Alamogordo, NM 88310-8703 | 2007-04-19 |
| 1396880084 | Gerald Champion Regional Medical Center | Obstetrics & Gynecology | 2559 Medical Dr, Suite D, Alamogordo, NM 88310-8703 | 2007-02-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1285249326 | Diana Cano | Behavior Technician | 27 N. Yucca Ave, Alamogordo, NM 88310 | 2020-09-15 |
| 1952802787 | Kinfe H Alemnugus | Pharmacist | 2669 N Scenic Dr, Inpatient Pharmacy, Alamogordo, NM 88310 | 2018-02-27 |
| 1134666902 | Hillary Elizabeth Hunter | Behavior Technician | 1908 Snow Dr, Alamogordo, NM 88310 | 2017-01-31 |
| 1285097774 | Adrienne Nicole Martin | Physician Assistant | 1501 E 10th Street, Pms-alamogordo Family Health Center, Alamogordo, NM 88310 | 2016-04-01 |
| 1487022919 | Crystal Jackson | Behavior Technician | 3205 Shawnee Trl, Alamogordo, NM 88310 | 2015-09-15 |
| 1851788798 | Timothy W. Basha | Counselor | 1613 Juniper Dr., Alamogordo, NM 88310 | 2015-04-17 |
| 1215331186 | Keith Edward Gerber | Case Manager/Care Coordinator | 1900 East Tenth Street, Alamogordo, NM 88310 | 2014-10-21 |
| 1710306691 | Austin Reed | Pharmacist | 2401 Indian Wells, Alamogordo, NM 88310 | 2014-04-08 |
| 1760821805 | Dollar Cab Company | Taxi | 1220 Brooks Ave., Alamogordo, NM 88310 | 2013-06-21 |
| 1932544319 | Peter Allan Lock | Physical Therapist | 1011 A 10th Street, Alamogordo, NM 88310 | 2013-04-30 |
| Find all providers in zip 88310 | ||||
| Taxonomy Code | 207RX0202X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Internal Medicine |
| Specialization | Medical Oncology |
| An internist who specializes in the diagnosis and treatment of all types of cancer and other benign and malignant tumors. This specialist decides on and administers therapy for these malignancies as well as consults with surgeons and radiotherapists on other treatments for cancer. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: added definition, added source. 11/5/2007: corrected definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1477882876 | Peter Bernat | Internal Medicine | 2559 Medical Dr, Suite G, Alamogordo, NM 88310-8703 | 2009-12-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558446187 | San Juan Oncology Associates, PC | Internal Medicine | 735 W Animas St, Farmington, NM 87401-5616 | 2006-10-25 |
| 1013940675 | Bernard M Agbemadzo | Internal Medicine | Pmg Hematology/oncology, 8300 Constitution Ave Ne, Albuquerque, NM 87110 | 2006-07-08 |
| 1932148384 | Constance Daphne Wash | Internal Medicine | 150 S Roadrunner Pkwy, Las Cruces, NM 88011-7044 | 2006-06-04 |
| 1366439101 | Richard Bush Ross | Internal Medicine | 2477 S Telshor Blvd, Las Cruces, NM 88011-5049 | 2005-10-05 |
| 1225031321 | Jan M Merin | Internal Medicine | 3917 West Rd, Los Alamos, NM 87544-2275 | 2005-05-23 |
| 1720081839 | Clark E Haskins | Internal Medicine | 4901 Lang Avenue Ne, Albuquerque, NM 87109-4397 | 2005-05-23 |
| 1831724517 | Joseph Ekofo | Internal Medicine | 2211 Lomas Blvd Ne, Albuquerque, NM 87106-2719 | 2020-03-03 |
| 1477804409 | Las Cruces Cancer Care LLC | Internal Medicine | 1180 Mall Dr, Suite B, Las Cruces, NM 88011-8101 | 2012-10-01 |
| 1609105139 | St. Vincent Hospital | Internal Medicine | 490 A W Zia Rd, Santa Fe, NM 87505-6996 | 2009-12-11 |
| 1750444915 | Esme E Finlay | Internal Medicine | 1201 Camino De Salud Ne, Albuquerque, NM 87102-4517 | 2006-12-19 |
| Find all providers with the same taxonomy | ||||
| City | ALAMOGORDO |
| Zip Code | 88310 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.