| Thoreau Clinic | |
|
3 Navarre Street Thoreau NM 87323 | |
| (505) 862-8250 | |
| (505) 862-8909 |
| Full Name | Thoreau Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 3 Navarre Street, Thoreau, New Mexico |
| Authorized Official Name and Position | Anslem Roanhorse (CEO) |
| Authorized Official Contact | 5057865291 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Thoreau Clinic Po Box 358 Crownpoint NM 87313-0358 Ph: (505) 786-5291 | Thoreau Clinic 3 Navarre Street Thoreau NM 87323 Ph: (505) 862-8250 |
| NPI Number | 1679516702 |
|---|---|
| Provider Enumeration Date | 06/14/2006 |
| Last Update Date | 10/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679516702 | NPI | - | NPPES |
| R2903 | Medicaid | NM | |
| HSZ145 | Other | NM | MEDICARE GROUP PTAN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Western Nm Medical Group Thoreau Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 15 Navarre, Thoreau, NM 87323 Phone: 505-862-7417 Fax: 505-862-8300 |