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IMMUNE CO MEDICAL GROUP PA
NPI 1285452458
Internal Medicine in Roswell, NM

Active since September 27, 2024
2500 BRANDON WAY, ROSWELL, NM 88201(512) 789-7580 Get Directions Write a Review

NPPES record last updated: September 27, 2024. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Immune Co Medical Group Pa NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

IMMUNE CO MEDICAL GROUP PA (NPI 1285452458) is a healthcare organization registered as an internal medicine in Roswell, New Mexico and active in the NPI registry since September 2024. The organization lists Ariana Thacker, Authorized Official, as its authorized official.

NPPES Registry Identity

NPI1285452458
Entity TypeOrganization
Primary Taxonomy207R00000X
Legal Business NameIMMUNE CO MEDICAL GROUP PA
Location Address2500 BRANDON WAYRoswell, NM 88201-9799
Mailing Address1000 Brickell Ave Ste 715Miami, FL 33131-3047 · (512) 789-7580
Phone(512) 789-7580
Organization SubpartNo
Authorized OfficialAriana ThackerAuthorized Official · (512) 789-7580
Enumeration DateSeptember 27, 2024
NPPES CertifiedSeptember 26, 2024
✔ NPI 1285452458 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyInternal MedicineAllopathic & Osteopathic Physicians
Taxonomy Code207R00000X
Definition
A physician who provides long-term, comprehensive care in the office and the hospital, managing both common and complex illness of adolescents, adults and the elderly. Internists are trained in the diagnosis and treatment of cancer, infections and diseases affecting the heart, blood, kidneys, joints and digestive, respiratory and vascular systems. They are also trained in the essentials of primary care internal medicine, which incorporates an understanding of disease prevention, wellness, substance abuse, mental health and effective treatment of common problems of the eyes, ears, skin, nervous system and reproductive organs.
Also ListedPhysician Assistant · MedicalTaxonomy 363AM0700X
Also ListedNurse Practitioner · FamilyTaxonomy 363LF0000X
Also ListedNurse's AideTaxonomy 376K00000X
2500 BRANDON WAY, Roswell, NM 88201
Open in Google Maps ↗

Other Names 1

Other NameMoldco

Group Practice 1

Group TaxonomyThis provider is a business group of one or more individual practitioners, who practice with different areas of specialization.193200000X MULTI-SPECIALTY GROUP

Other Providers at the Same Location NPPES

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

DR. KALI KUNDOMAL DNP, BSN, RN
Nurse Practitioner (Family)
2500 BRANDON WAY
ROSWELL, NM 88201
Chaves County (575) 420-9542

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Immune Co Medical Group PA's NPI number?

The NPI number for Immune Co Medical Group PA is 1285452458. It was assigned to this organization in the NPPES registry on September 27, 2024. The provider is also known as MoldCo.

Where is Immune Co Medical Group PA located?

Immune Co Medical Group PA is located at 2500 Brandon Way, Roswell, NM 88201. The listed phone number is (512) 789-7580.

What is Immune Co Medical Group PA's specialty?

The primary specialty registered for this NPI is Internal Medicine with taxonomy code 207R00000X.

When was this NPI record last updated?

The NPPES record for Immune Co Medical Group PA was last updated on September 27, 2024. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 22 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.