Healthcare Provider Details

I. General information

NPI: 1992781553
Provider Name (Legal Business Name): TURQUOISE, LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 S 2ND ST
RATON NM
87740-2301
US

IV. Provider business mailing address

PO BOX 2407
SHERMAN TX
75091-2407
US

V. Phone/Fax

Practice location:
  • Phone: 505-445-3131
  • Fax:
Mailing address:
  • Phone: 903-893-0677
  • Fax: 903-893-3639

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPH2393
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH2393
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPH2393
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License NumberPH2393
License Number StateNM

VIII. Authorized Official

Name: JOHN STOGNER
Title or Position: CFO
Credential:
Phone: 903-893-0677