Healthcare Provider Details

I. General information

NPI: 1124787247
Provider Name (Legal Business Name): APP OF NEW MEXICO HM PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2021
Last Update Date: 01/27/2023
Certification Date: 01/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 W COUNTRY CLUB RD
ROSWELL NM
88201-5209
US

IV. Provider business mailing address

5121 MARYLAND WAY STE 300
BRENTWOOD TN
37027-7516
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-8170
  • Fax: 629-216-0568
Mailing address:
  • Phone: 855-246-8607
  • Fax: 629-216-0568

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: JAMES GRIMES
Title or Position: CFO
Credential:
Phone: 855-246-8607