Healthcare Provider Details

I. General information

NPI: 1558265587
Provider Name (Legal Business Name): SIMPLICITY HEALTH OF NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 N WHITE SANDS BLVD STE 110A
ALAMOGORDO NM
88310-6774
US

IV. Provider business mailing address

1200 N WHITE SANDS BLVD STE 110A
ALAMOGORDO NM
88310-6774
US

V. Phone/Fax

Practice location:
  • Phone: 575-488-0030
  • Fax: 575-488-0032
Mailing address:
  • Phone: 575-488-0030
  • Fax: 575-488-0032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QD0401X
TaxonomyDiabetology (Family Medicine) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JEREMY FULTZ
Title or Position: PRESIDENT
Credential:
Phone: 575-488-0030