| Main Street Medical Center, Llc | |
|
200 Pioneer Rd Ste A Red River NM 87558-0010 | |
| (575) 754-6330 | |
| (575) 754-6232 |
| Full Name | Main Street Medical Center, Llc |
|---|---|
| Speciality | Nurse Practitioner - Family |
| Location | 200 Pioneer Rd, Red River, New Mexico |
| Authorized Official Name and Position | Jessica L Cross (OWNER) |
| Authorized Official Contact | 5757546330 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Main Street Medical Center, Llc Po Box 10 Red River NM 87558-0010 Ph: (575) 779-8015 | Main Street Medical Center, Llc 200 Pioneer Rd Ste A Red River NM 87558-0010 Ph: (575) 754-6330 |
| NPI Number | 1225389919 |
|---|---|
| Provider Enumeration Date | 09/21/2012 |
| Last Update Date | 03/04/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225389919 | NPI | - | NPPES |
| 1225389919 | Other | NM | ORG 2 NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | CNP-01822 (New Mexico) | Primary |
Red River Primary Care Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 200 A Pioneer Road, Red River, NM 87558 Phone: 575-754-1773 Fax: 505-989-3536 |