Healthcare Provider Details

I. General information

NPI: 1669208401
Provider Name (Legal Business Name): LA PLATA MEDICAL EXAMINERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2024
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

783 NEW MEXICO 170
FARMINGTON NM
87401-8700
US

IV. Provider business mailing address

783 NEW MEXICO 170
FARMINGTON NM
87401-8700
US

V. Phone/Fax

Practice location:
  • Phone: 505-556-1999
  • Fax: 505-675-2788
Mailing address:
  • Phone: 505-556-1999
  • Fax: 505-675-2788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAMON KALCICH
Title or Position: PRESIDENT
Credential: DO
Phone: 505-556-1999