Healthcare Provider Details

I. General information

NPI: 1104179175
Provider Name (Legal Business Name): SUNBELT OASIS EMERGENCY PHYSICIANS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2012
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

42121 US HWY 70
PORTALES NM
88130
US

IV. Provider business mailing address

P.O. BOX 98729
LAS VEGAS NV
89193-8729
US

V. Phone/Fax

Practice location:
  • Phone: 575-359-1800
  • Fax: 575-356-9210
Mailing address:
  • Phone: 800-444-7009
  • Fax: 800-305-3233

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KATHY KONDAS
Title or Position: OFFICER
Credential:
Phone: 954-838-2371