Healthcare Provider Details

I. General information

NPI: 1679644728
Provider Name (Legal Business Name): ENT ASSOCIATES OF SOUTHEASTERN NEW MEXICO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5419 N LOVINGTON HWY
HOBBS NM
88240-9131
US

IV. Provider business mailing address

PO BOX 2484
HOBBS NM
88241-2484
US

V. Phone/Fax

Practice location:
  • Phone: 505-392-0495
  • Fax: 505-392-0562
Mailing address:
  • Phone: 505-392-0495
  • Fax: 505-392-0562

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2002-0332
License Number StateNM

VIII. Authorized Official

Name: DR. GEORGE J FARRELL III
Title or Position: PRESIDENT
Credential: MD
Phone: 505-392-0495