Healthcare Provider Details

I. General information

NPI: 1881699031
Provider Name (Legal Business Name): NEW MEXICO PROSTHETIC-ORTHOTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2515 N KENTUCKY AVE
ROSWELL NM
88201-5807
US

IV. Provider business mailing address

2515 N KENTUCKY AVE
ROSWELL NM
88201-5807
US

V. Phone/Fax

Practice location:
  • Phone: 505-623-0344
  • Fax:
Mailing address:
  • Phone: 505-623-0344
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State

VIII. Authorized Official

Name: ADAM DUTCHOVER
Title or Position: OWNER-PRESIDENT
Credential: CPO
Phone: 505-623-0344