Healthcare Provider Details

I. General information

NPI: 1174231484
Provider Name (Legal Business Name): ROSWELL INFUSIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2022
Last Update Date: 03/05/2026
Certification Date: 03/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 S LEA AVE # 4
ROSWELL NM
88203-4562
US

IV. Provider business mailing address

PO BOX 102
ROSWELL NM
88202-0102
US

V. Phone/Fax

Practice location:
  • Phone: 575-347-1883
  • Fax:
Mailing address:
  • Phone: 575-347-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: PRESTON KING
Title or Position: DIRECTOR
Credential: DNP, CRNA.
Phone: 573-429-1313