Healthcare Provider Details

I. General information

NPI: 1134499262
Provider Name (Legal Business Name): ROSWELL FAMILY CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2012
Last Update Date: 01/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 N MAIN ST
ROSWELL NM
88201-4824
US

IV. Provider business mailing address

614 N MAIN ST
ROSWELL NM
88201-4824
US

V. Phone/Fax

Practice location:
  • Phone: 719-203-5023
  • Fax: 719-503-5024
Mailing address:
  • Phone: 719-203-5023
  • Fax: 719-503-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MRS. ELIZABETH SCHEAR
Title or Position: OFFICE MANAGER
Credential:
Phone: 719-203-5023