| N/a | |
|
2000 W 21st St Ste R1 Clovis NM 88101-4098 | |
| (575) 935-0944 | |
| (575) 935-0948 |
| Full Name | N/a |
|---|---|
| Speciality | Clinic/Center |
| Location | 2000 W 21st St Ste R1, Clovis, New Mexico |
| Authorized Official Name and Position | William E Boyer (CHIEF FINANCIAL OFFICER) |
| Authorized Official Contact | 5753563416 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| N/a Po Box 299 Portales NM 88130-0299 Ph: (575) 356-6652 | N/a 2000 W 21st St Ste R1 Clovis NM 88101-4098 Ph: (575) 935-0944 |
| NPI Number | 1578639662 |
|---|---|
| Provider Enumeration Date | 11/28/2006 |
| Last Update Date | 04/15/2019 |
| Medicare PECOS PAC ID | 4082526660 |
|---|---|
| Medicare Enrollment ID | O20190523000788 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578639662 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QR1300X | Clinic/center - Rural Health | (* (Not Available)) | Primary |
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