MEDICARE: DEMING CLINIC CORPORATION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	207V00000X	Obstetrics & Gynecology Physician
2	207X00000X	Orthopaedic Surgery Physician
3	208800000X	Urology Physician
4	207Q00000X	Family Medicine Physician	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205835808
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DEMING CLINIC CORPORATION

Provider Business Mailing Address
First Line	:	1573 MALLORY LN STE 100
Second Line	:
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-2895
Country	:	US
Telephone Number	:	152-221-1400
Fax Number	:

Provider Business Practice Location Address
First Line	:	905 S 8TH ST STE A
Second Line	:
City	:	DEMING
State	:	NM
Zip	:	88030-4037
Country	:	US
Telephone Number	:	575-543-7200
Fax Number	:

Authorized Official
Title or Position	:	SR. DIRECTOR PHYSICIAN REV CYCLE
Name	:	LAURA J FEY
Credential	:
Telephone Number	:	615-221-3641

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	07/07/2023

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Directions to “DEMING CLINIC CORPORATION ” Practice Location

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