Healthcare Provider Details

I. General information

NPI: 1801859319
Provider Name (Legal Business Name): SPROCKET MEDICAL MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2006
Last Update Date: 03/11/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 N LOVINGTON HWY
HOBBS NM
88240-9100
US

IV. Provider business mailing address

5419 N LOVINGTON HWY
HOBBS NM
88240-9100
US

V. Phone/Fax

Practice location:
  • Phone: 505-491-5000
  • Fax:
Mailing address:
  • Phone: 505-491-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State

VIII. Authorized Official

Name: MS. DEBBIE BREWER
Title or Position: PROVIDER ENROLLMENT DIRECTOR
Credential:
Phone: 877-892-9813