Healthcare Provider Details

I. General information

NPI: 1992438873
Provider Name (Legal Business Name): APP ICU, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 07/07/2022
Certification Date: 07/07/2022
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 TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES SOMERBY
Title or Position: SVP
Credential:
Phone: 855-246-8607