1366010829 NPI number — PATRICIA M MESTER LADAC

Table of content: PATRICIA M MESTER LADAC (NPI 1366010829)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366010829 NPI number — PATRICIA M MESTER LADAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MESTER
Provider First Name:
PATRICIA
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LADAC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1366010829
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/24/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1311 N GRANT ST STE A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER CITY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88061-5134
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-388-1447
Provider Business Mailing Address Fax Number:
575-388-1447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
603 HADECO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LORDSBURG
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88045-1834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-542-8447
Provider Business Practice Location Address Fax Number:
575-542-8447
Provider Enumeration Date:
06/11/2021

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 175T00000X , with the licence number:  1132 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YA0400X , with the licence number: CBT-2023-0449 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 62879821 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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