Healthcare Provider Details

I. General information

NPI: 1841204294
Provider Name (Legal Business Name): NEW MEXICO QUICKCARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 MILLS AVE STE 200
LAS VEGAS NM
87701-4169
US

IV. Provider business mailing address

105 MILLS AVE STE 200
LAS VEGAS NM
87701-4169
US

V. Phone/Fax

Practice location:
  • Phone: 505-454-1109
  • Fax: 505-454-1779
Mailing address:
  • Phone: 505-454-1109
  • Fax: 505-454-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LAURIE HAYS
Title or Position: CHIEF OPERATION OFFICER
Credential:
Phone: 505-454-1109