Healthcare Provider Details

I. General information

NPI: 1760379325
Provider Name (Legal Business Name): NEW MEXICO PREMIER HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2025
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 SANDSAGE RD NW
LOS LUNAS NM
87031
US

IV. Provider business mailing address

235 MAIN ST SE
LOS LUNAS NM
87031-7316
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-2223
  • Fax:
Mailing address:
  • Phone: 505-388-2223
  • Fax:

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: AMANDA CHRISTINE RENFRO
Title or Position: OWNER/CMO
Credential: APRN
Phone: 817-897-5310