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NPI Code Detail

MEDICARE: PMS DBA ROUNDTREE CHILDRENS' DEVELOPMENT SERVICES

MEDICARE: PMS DBA ROUNDTREE CHILDRENS' DEVELOPMENT SERVICES
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
1261QD1600XDevelopmental Disabilities Clinic/CenterNM

Other Identifiers

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

General Provider Information

NPI Number : 1326195769
Entity Type Code : Organization
Provider Name (Legal Business Name) : PMS DBA ROUNDTREE CHILDRENS' DEVELOPMENT SERVICES
Provider Business Mailing Address
First Line : 608 REILLY AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87499
Country : US
Telephone Number : 505-327-7720
Fax Number : 505-992-4990
Provider Business Practice Location Address
First Line : 608 REILLY AVE
Second Line :
City : FARMINGTON
State : NM
Zip : 87401-2634
Country : US
Telephone Number : 505-443-4303
Fax Number : 505-443-8311
Authorized Official
Title or Position : EXECUTIVE VICE PRESIDENT
Name : DOUG SMITH
Credential :
Telephone Number : 505-982-5565
Provider Enumeration Date : 01/05/2007
Last Update Date : 04/07/2022

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Directions to “PMS DBA ROUNDTREE CHILDRENS' DEVELOPMENT SERVICES ” Practice Location

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