MEDICARE: SONOMA URGENT CARE LLC

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	:	1740694223
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SONOMA URGENT CARE LLC

Provider Business Mailing Address
First Line	:	4371 E. LOHMAN AVE.
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-8255
Country	:	US
Telephone Number	:	575-532-8900
Fax Number	:	575-532-8963

Provider Business Practice Location Address
First Line	:	2970 N MAIN ST
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88001-1152
Country	:	US
Telephone Number	:	575-532-8900
Fax Number	:	575-532-8963

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. EUGENE SAMUEL
Credential	:
Telephone Number	:	575-532-8900

Provider Enumeration Date	:	06/12/2014
Last Update Date	:	06/12/2014

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Directions to “SONOMA URGENT CARE LLC ” Practice Location

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