Healthcare Provider Details

I. General information

NPI: 1972941474
Provider Name (Legal Business Name): SPINE AND ORTHOPEDIC CENTER OF NEW MEXICO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 01/27/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 N PENNSYLVANIA AVE SUITE 101
ROSWELL NM
88201-4754
US

IV. Provider business mailing address

400 N PENNSYLVANIA AVE SUITE 101
ROSWELL NM
88201-4754
US

V. Phone/Fax

Practice location:
  • Phone: 575-623-9101
  • Fax: 575-623-3020
Mailing address:
  • Phone: 575-623-9101
  • Fax: 575-623-3020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License Number2002-0310
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code207XS0114X
TaxonomyAdult Reconstructive Orthopaedic Surgery Physician
License Number2002-0310
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number2002-0310
License Number StateNM

VIII. Authorized Official

Name: DR. OMAR NIZAR OSMANI
Title or Position: OWNER
Credential: M.D.
Phone: 575-623-9101