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204 Angelina Blvd. Chaparral NM 88081 | |
(575) 824-0144 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 204 Angelina Blvd., Chaparral, New Mexico |
Authorized Official Name and Position | Roberta Lee (CHIEF FINANCIAL OFFICER) |
Authorized Official Contact | 5059825565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | 204 Angelina Blvd. Chaparral NM 88081 Ph: (575) 824-0144 |
NPI Number | 1174845143 |
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Provider Enumeration Date | 02/18/2010 |
Last Update Date | 02/18/2010 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20101109001250 |
Identifier | Type | State | Issuer |
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1174845143 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
County Line Medical Service Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 545 S County Line Dr Spc A, Chaparral, NM 88081 Phone: 575-824-5007 | |