Healthcare Provider Details

I. General information

NPI: 1174551121
Provider Name (Legal Business Name): NEW MEXICO QUICKCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 07/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 NORTH TELSHOR SUITE C
LAS CRUCES NM
88011
US

IV. Provider business mailing address

629 - 12TH STREET NEW MEXICO QUICKCARE LLC
LAS VEGAS NM
87701
US

V. Phone/Fax

Practice location:
  • Phone: 575-532-2004
  • Fax: 575-532-2441
Mailing address:
  • Phone: 505-454-9531
  • Fax: 505-426-8038

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DEAN SCHEAR
Title or Position: CEO
Credential:
Phone: 505-454-9531