Healthcare Provider Details

I. General information

NPI: 1811925662
Provider Name (Legal Business Name): SCOR PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 10/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 E 19TH ST
ROSWELL NM
88201-5151
US

IV. Provider business mailing address

115 E 19TH ST
ROSWELL NM
88201-5151
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-7600
  • Fax: 575-622-3856
Mailing address:
  • Phone: 575-622-7600
  • Fax: 575-622-3856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY ROEHLK
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 575-622-7600