Healthcare Provider Details

I. General information

NPI: 1487246229
Provider Name (Legal Business Name): PRESBYTERIAN RUST MEDICAL CENTER ASC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/03/2021
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 UNSER BLVD SE STE 09100B
RIO RANCHO NM
87124
US

IV. Provider business mailing address

14201 DALLAS PKWY LEGAL- 13TH FLOOR
DALLAS TX
75254
US

V. Phone/Fax

Practice location:
  • Phone: 720-245-0321
  • Fax: 505-355-5912
Mailing address:
  • Phone: 469-872-4706
  • Fax: 972-767-3547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ERIC BOON
Title or Position: OFFICER/AUTHORIZED OFFICIAL
Credential:
Phone: 480-567-0269