Healthcare Provider Details

I. General information

NPI: 1801030093
Provider Name (Legal Business Name): MCGUIRE WOUND & OSTOMY CENTER PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2009
Last Update Date: 07/27/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1717 W 2ND ST SUITE 101
ROSWELL NM
88201-2000
US

IV. Provider business mailing address

PO BOX 1555
ROSWELL NM
88202
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberR38567
License Number StateNM

VIII. Authorized Official

Name: RANDALL MCGUIRE
Title or Position: OWNER
Credential:
Phone: 575-624-2095