Healthcare Provider Details

I. General information

NPI: 1932380904
Provider Name (Legal Business Name): LINCOLN COUNTY FAMILY MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/19/2007
Last Update Date: 11/19/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 SUDDERTH DR
RUIDOSO NM
88345-6104
US

IV. Provider business mailing address

1401 SUDDERTH DR
RUIDOSO NM
88345-6104
US

V. Phone/Fax

Practice location:
  • Phone: 575-257-7712
  • Fax: 575-257-4513
Mailing address:
  • Phone: 575-257-7712
  • Fax: 575-257-4513

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number82-170
License Number StateNM

VIII. Authorized Official

Name: ARLENE M BROWN
Title or Position: OWNER
Credential: MD
Phone: 575-257-7712