Healthcare Provider Details

I. General information

NPI: 1497851208
Provider Name (Legal Business Name): RELIANCE MEDICAL GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 05/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 N BUTLER AVE
FARMINGTON NM
87401
US

IV. Provider business mailing address

3451 N BUTLER AVE
FARMINGTON NM
87401-2357
US

V. Phone/Fax

Practice location:
  • Phone: 505-566-1915
  • Fax: 505-566-1918
Mailing address:
  • Phone: 505-566-1915
  • Fax: 505-566-1918

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES L HOLGATE
Title or Position: VICE PRESIDENT
Credential:
Phone: 505-566-1915