Healthcare Provider Details

I. General information

NPI: 1700393782
Provider Name (Legal Business Name): MCLEOD MEDICAL CENTERS OF NM, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2017
Last Update Date: 06/05/2024
Certification Date: 06/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12127B HWY 14 N STE 5
CEDAR CREST NM
87008-9499
US

IV. Provider business mailing address

12127B HWY 14 N STE 5
CEDAR CREST NM
87008-9499
US

V. Phone/Fax

Practice location:
  • Phone: 505-281-5180
  • Fax: 505-281-5320
Mailing address:
  • Phone: 505-281-5180
  • Fax: 505-281-5320

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA G. MARRUFO
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 505-916-6544