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#24 Highway 73 Penasco NM 87553-0205 | |
(575) 587-1833 | |
(575) 587-1918 |
Full Name | |
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Speciality | Clinic/center - Community Health |
Location | #24 Highway 73, Penasco, New Mexico |
Authorized Official Name and Position | Patrick E Rose (SPECIAL PROJECTS) |
Authorized Official Contact | 5757518905 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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1397 Weimer Rd Taos NM 87571-6253 Ph: (575) 751-8905 | #24 Highway 73 Penasco NM 87553-0205 Ph: (575) 587-1833 |
NPI Number | 1669521282 |
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Provider Enumeration Date | 01/10/2007 |
Last Update Date | 04/19/2011 |
Identifier | Type | State | Issuer |
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1669521282 | NPI | - | NPPES |
S5239 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
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261QC1500X | Clinic/center - Community Health | (* (Not Available)) | Primary |