Healthcare Provider Details

I. General information

NPI: 1871917740
Provider Name (Legal Business Name): APEXNETWORK NEW MEXICO,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 W MALONEY AVE
GALLUP NM
87301-5307
US

IV. Provider business mailing address

15 APEX DR
HIGHLAND IL
62249-1282
US

V. Phone/Fax

Practice location:
  • Phone: 618-651-0444
  • Fax:
Mailing address:
  • Phone: 618-651-0444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State

VIII. Authorized Official

Name: STEVEN ORAVEC
Title or Position: MANAGING PARTNER
Credential:
Phone: 618-651-0444