| Cottonwood Family Medicine Llc | |
|
4940 Corrales Rd Suite 200 Corrales NM 87048-8673 | |
| (505) 929-0663 | |
| Not Available |
| Full Name | Cottonwood Family Medicine Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 4940 Corrales Rd, Corrales, New Mexico |
| Authorized Official Name and Position | Katie Boylan (SOLE MEMBER/NURSE PRACTITIONER) |
| Authorized Official Contact | 5059290663 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cottonwood Family Medicine Llc 7117 Hapsburg Rd Ne Rio Rancho NM 87144-6608 Ph: (505) 929-0663 | Cottonwood Family Medicine Llc 4940 Corrales Rd Suite 200 Corrales NM 87048-8673 Ph: (505) 929-0663 |
| NPI Number | 1528429438 |
|---|---|
| Provider Enumeration Date | 03/19/2016 |
| Last Update Date | 03/19/2016 |
| Medicare PECOS PAC ID | 8123327590 |
|---|---|
| Medicare Enrollment ID | O20160506000432 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528429438 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | CNP02459 (New Mexico) | Primary |
| Provider Name | William Francis Fitzpatrick |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538267984 PECOS PAC ID: 0244424760 Enrollment ID: I20101028001270 |
| Provider Name | Katie L Boylan |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669885182 PECOS PAC ID: 7214250786 Enrollment ID: I20150108001902 |
| Provider Name | Joan Lewis |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1538203856 PECOS PAC ID: 4789661497 Enrollment ID: I20160511001199 |
| Provider Name | Lisa A Johnson |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1396840211 PECOS PAC ID: 8224053673 Enrollment ID: I20190508000691 |
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