MEDICARE: NEWMEXIDOC, PA.

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1316358989
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEWMEXIDOC, PA.

Provider Business Mailing Address
First Line	:	PO BOX 1846
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87504-1846
Country	:	US
Telephone Number	:	505-501-7791
Fax Number	:	505-501-7792

Provider Business Practice Location Address
First Line	:	831 S SAINT FRANCIS DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87505-3027
Country	:	US
Telephone Number	:	505-501-7791
Fax Number	:	505-501-7792

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	DR. TROY EDWARD WATSON
Credential	:	M.D.
Telephone Number	:	505-501-7791

Provider Enumeration Date	:	05/16/2014
Last Update Date	:	05/20/2015

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