Internal Medicine
IMMUNE CO MEDICAL GROUP PA
Identity confirmed via CMS NPPES · September 30, 2026 · A directory match is not a coverage approval.
Is this your practice? This listing was imported from public provider identity data (CMS NPPES) and has not yet been claimed. Claim this listing to confirm the practice details. Plan acceptance stays unpublished until the practice reports it.
Public record
NPI 1285452458 · enumerated 2024-09-27 · record updated 2024-09-27. Source: CMS NPPES. A listing is not a TRICARE network approval.
NPPES recordGoogle Maps Apple Maps OpenStreetMap
Authorized official: ARIANA THACKER, Authorized Official · (512) 789-7580
Other names: MOLDCO
Addresses and phones
- Mailing address 1000 BRICKELL AVE STE 715, MIAMI, FL, 33131-3047 (512) 789-7580 Google Maps Apple Maps OpenStreetMap
- Practice location 2500 BRANDON WAY, ROSWELL, NM, 88201-9799 (512) 789-7580 Google Maps Apple Maps OpenStreetMap
Specialties
- Internal Medicine 207R00000X · Primary
- Physician Assistant, Medical 363AM0700X
- Nurse Practitioner, Family 363LF0000X
- Nurse's Aide 376K00000X
In this directory
Locations and evidence
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Practice location
ROSWELL, NM, 882019799
Accepting new patientsNot reportedCMS NPPES · September 30, 2026
Plan acceptance
- No published plan acceptance yet. Confirm directly with the practice, or claim this listing if it's yours.