Healthcare Provider Details

I. General information

NPI: 1447585914
Provider Name (Legal Business Name): WHOLE WORLD HEALTH CARE, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2009
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

109 W. BLAND
ROSWELL NM
88203
US

IV. Provider business mailing address

PO BOX 875
ROSWELL NM
88202-0875
US

V. Phone/Fax

Practice location:
  • Phone: 575-627-5571
  • Fax: 575-624-6430
Mailing address:
  • Phone: 575-624-2095
  • Fax: 575-627-5721

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number92-302
License Number StateNM

VIII. Authorized Official

Name: DR. SCOTT W MCMAHON
Title or Position: OWNER
Credential: M.D.
Phone: 575-627-5571