Healthcare Provider Details

I. General information

NPI: 1730131848
Provider Name (Legal Business Name): VIA CHRISTI MEDICAL CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 11/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 E MANANA BLVD UNIT 1
CLOVIS NM
88101-3503
US

IV. Provider business mailing address

PO BOX 520
CLOVIS NM
88102-0520
US

V. Phone/Fax

Practice location:
  • Phone: 575-742-2500
  • Fax: 575-742-9878
Mailing address:
  • Phone: 575-742-2500
  • Fax: 575-742-9878

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2001-306
License Number StateNM

VIII. Authorized Official

Name: DR. HARRY KYLE SHEETS
Title or Position: CLINIC ADMINISTRATOR
Credential: M.D.
Phone: 575-742-2500