MEDICARE: DAVES HEALTH SERVICES, 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	261QH0100X	Health Service Clinic/Center	R57579	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	:	1750687190
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DAVES HEALTH SERVICES, LLC

Provider Business Mailing Address
First Line	:	110 S HALAGUENO ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5748
Country	:	US
Telephone Number	:	575-234-1644
Fax Number	:	575-887-2685

Provider Business Practice Location Address
First Line	:	110 S HALAGUENO ST
Second Line	:
City	:	CARLSBAD
State	:	NM
Zip	:	88220-5748
Country	:	US
Telephone Number	:	575-234-1644
Fax Number	:	575-887-2685

Authorized Official
Title or Position	:	MEMBER
Name	:	DAVID B CULP
Credential	:	CNP
Telephone Number	:	575-234-1644

Provider Enumeration Date	:	02/02/2011
Last Update Date	:	07/25/2011

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Directions to “DAVES HEALTH SERVICES, LLC ” Practice Location

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