Healthcare Provider Details

I. General information

NPI: 1639121759
Provider Name (Legal Business Name): SURGERY CENTER OF EASTERN NEW MEXICO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2421 W 21ST ST
CLOVIS NM
88101-2006
US

IV. Provider business mailing address

2421 W 21ST ST
CLOVIS NM
88101-2006
US

V. Phone/Fax

Practice location:
  • Phone: 505-763-8800
  • Fax: 505-763-2630
Mailing address:
  • Phone: 505-763-8800
  • Fax: 505-763-2630

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. CASEY MCFARLAND
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 505-763-2609