Healthcare Provider Details

I. General information

NPI: 1124213384
Provider Name (Legal Business Name): SPROKET MEDICAL MANAGEMET
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2007
Last Update Date: 07/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 N DAL PASO ST
HOBBS NM
88240-3045
US

IV. Provider business mailing address

2430 W PIERCE ST
CARLSBAD NM
88220-3553
US

V. Phone/Fax

Practice location:
  • Phone: 505-492-9675
  • Fax: 505-397-0282
Mailing address:
  • Phone: 505-628-0926
  • Fax: 505-628-0493

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: TOBY HERRING
Title or Position: MANAGER
Credential:
Phone: 505-492-9675