Full Name | |
---|---|
Speciality | General Practice |
Location | 471 Main St, Corona, New Mexico |
Authorized Official Name and Position | Bo Beames (VP RDS) |
Authorized Official Contact | 5758358700 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 26666 Albuquerque NM 87125-6666 Ph: (505) 923-5356 | 471 Main St Corona NM 88318 Ph: (575) 849-1561 |
NPI Number | 1912324930 |
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Provider Enumeration Date | 03/27/2014 |
Last Update Date | 03/27/2014 |
Identifier | Type | State | Issuer |
---|---|---|---|
1912324930 | NPI | - | NPPES |
07773242 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208D00000X | General Practice | 3156 (New Mexico) | Primary |