Healthcare Provider Details

I. General information

NPI: 1922896836
Provider Name (Legal Business Name): EXCEPTIONAL PHYSICIANS GROUP FARMINGTON HOSPITAL PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2670 E PINON FRONTAGE RD
FARMINGTON NM
87402
US

IV. Provider business mailing address

3514 CEDAR SPRINGS RD
DALLAS TX
75219-4901
US

V. Phone/Fax

Practice location:
  • Phone: 469-341-7800
  • Fax: 469-807-1208
Mailing address:
  • Phone: 469-341-7800
  • Fax: 469-807-1208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RONALD IVAN COLLINS
Title or Position: DIRECTOR
Credential:
Phone: 972-740-9335