Healthcare Provider Details

I. General information

NPI: 1023151966
Provider Name (Legal Business Name): RIO PECOS MEDICAL ASSOCIATES LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2007
Last Update Date: 11/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

305 W COUNTRY CLUB RD
ROSWELL NM
88201-5892
US

IV. Provider business mailing address

PO BOX 2608
ROSWELL NM
88202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 575-622-6322
  • Fax: 575-622-6888
Mailing address:
  • Phone: 575-622-6322
  • Fax: 575-622-6888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code291U00000X
TaxonomyClinical Medical Laboratory
License Number
License Number StateNM

VIII. Authorized Official

Name: MR. CODY DODSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 575-622-6322