Healthcare Provider Details

I. General information

NPI: 1033163076
Provider Name (Legal Business Name): RIO PECOS MEDICAL ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/22/2006
Last Update Date: 10/28/2025
Certification Date: 10/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W COUNTRY CLUB RD
ROSWELL NM
88201-5892
US

IV. Provider business mailing address

PO BOX 2608
ROSWELL NM
88202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-6322
  • Fax: 575-622-6888
Mailing address:
  • Phone: 575-622-6322
  • Fax: 575-622-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number0180602500
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JERRY VELASQUEZ
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-622-6322