| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 6362 Main Street, Cuba, New Mexico |
| Authorized Official Name and Position | Richard Kozoll (PROPRIETOR) |
| Authorized Official Contact | 5052893326 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1659 Cuba NM 87013-1659 Ph: (505) 289-3326 | 6362 Main Street Cuba NM 87013 Ph: (505) 289-3326 |
| NPI Number | 1912918467 |
|---|---|
| Provider Enumeration Date | 08/10/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912918467 | NPI | - | NPPES |
| 46338 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 72-173 (New Mexico) | Primary |
Pueblo Pintado Clinic Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: #10 Pueblo Pintado School, Cuba, NM 87013 Phone: 505-655-3501 Fax: 505-862-8909 | |