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309 Red Sun Dr Chaparral NM 88081-7966 | |
(505) 824-0383 | |
(505) 824-0375 |
Full Name | |
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Speciality | Clinic/center - Primary Care |
Location | 309 Red Sun Dr, Chaparral, New Mexico |
Authorized Official Name and Position | Edward Rogers Kemp (OWNER/PROVIDER) |
Authorized Official Contact | 5058240383 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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309 Red Sun Dr Chaparral NM 88081-7966 Ph: (505) 824-0383 | 309 Red Sun Dr Chaparral NM 88081-7966 Ph: (505) 824-0383 |
NPI Number | 1881607679 |
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Provider Enumeration Date | 08/14/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1881607679 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QP2300X | Clinic/center - Primary Care | R40093 (New Mexico) | Primary |
County Line Medical Service Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 545 S County Line Dr Spc A, Chaparral, NM 88081 Phone: 575-824-5007 | |