Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Immune Co Medical Group PA

Organization Internal Medicine Physician · NPI 1285452458

Immune Co Medical Group PA is an Internal Medicine Physician in Roswell, New Mexico. Registered with an NPI since 2024.

In the registry since
2024
Specialties on file
4
What do these letters mean?
PA — Professional association
A form of business registration, not a clinical qualification.

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Practice location Address checks out

2500 Brandon Way
Roswell, NM 88201-9799
Phone: (512) 789-7580
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X
Medical Physician Assistant Taxonomy 363AM0700X
Family Nurse Practitioner Taxonomy 363LF0000X
Nurse's Aide Taxonomy 376K00000X

Record details

NPI number1285452458
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Ariana Thacker — Authorized Official · (512) 789-7580
Other names Moldco
NPI enumeratedSeptember 27, 2024
Last updated in NPPESSeptember 27, 2024
Certification dateSeptember 26, 2024
Mailing address1000 Brickell Ave Ste 715, Miami, FL 33131-3047

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