Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 471 Main Street, Corona, New Mexico |
Authorized Official Name and Position | Bo Beames (VP REGIONAL DELIVERY SYSTEM) |
Authorized Official Contact | 5758358341 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 26666 Provider Enrollment Albuquerque NM 87125-6666 Ph: (505) 923-5356 | 471 Main Street Corona NM 88318 Ph: (505) 849-1561 |
NPI Number | 1538144415 |
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Provider Enumeration Date | 12/13/2005 |
Last Update Date | 04/23/2014 |
Medicare PECOS PAC ID | 9234041708 |
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Medicare Enrollment ID | O20040820000217 |
Identifier | Type | State | Issuer |
---|---|---|---|
1538144415 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QR1300X | Clinic/center - Rural Health | 3156 (New Mexico) | Primary |