| Sierra Blanca Family Medicine Pc | |
|
208 Porr Dr Ruidoso NM 88345-6713 | |
| (575) 630-1214 | |
| (575) 630-2083 |
| Full Name | Sierra Blanca Family Medicine Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 208 Porr Dr, Ruidoso, New Mexico |
| Authorized Official Name and Position | Frank J Dimotta (PROVIDER OWNER) |
| Authorized Official Contact | 5756301214 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Sierra Blanca Family Medicine Pc 208 Porr Dr Ruidoso NM 88345-6713 Ph: (575) 630-1214 | Sierra Blanca Family Medicine Pc 208 Porr Dr Ruidoso NM 88345-6713 Ph: (575) 630-1214 |
| NPI Number | 1992132500 |
|---|---|
| Provider Enumeration Date | 09/27/2013 |
| Last Update Date | 09/27/2013 |
| Medicare PECOS PAC ID | 1850521246 |
|---|---|
| Medicare Enrollment ID | O20140304001639 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1992132500 | NPI | - | NPPES |
| 72884 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 2000-25 (New Mexico) | Primary |
| Provider Name | Frank J Dimotta |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1699740910 PECOS PAC ID: 8022196377 Enrollment ID: I20100422000536 |
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