Healthcare Provider Details

I. General information

NPI: 1144966136
Provider Name (Legal Business Name): G & M MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2022
Last Update Date: 11/01/2022
Certification Date: 11/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 JACKIE RD SE STE 400
RIO RANCHO NM
87124-1045
US

IV. Provider business mailing address

1316 JACKIE RD SE STE 500
RIO RANCHO NM
87124-6607
US

V. Phone/Fax

Practice location:
  • Phone: 505-415-0719
  • Fax: 505-372-0093
Mailing address:
  • Phone: 505-415-0719
  • Fax: 505-372-0093

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: RONALD M EDWARDS
Title or Position: OWNER/PROVIDER
Credential: FNP-BC AGACNP
Phone: 505-415-0719