Healthcare Provider Details

I. General information

NPI: 1326681891
Provider Name (Legal Business Name): MRS. RITA ANN DICKINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 PORR DR
RUIDOSO NM
88345-6713
US

IV. Provider business mailing address

243 RICHARDSON CANYON RD
CAPITAN NM
88316-5300
US

V. Phone/Fax

Practice location:
  • Phone: 575-630-1214
  • Fax: 575-630-2083
Mailing address:
  • Phone: 575-354-0044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: