Healthcare Provider Details

I. General information

NPI: 1669608212
Provider Name (Legal Business Name): HEALING WATERS FAMILY MEDICINE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2009
Last Update Date: 06/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

455 S FOCH ST
TRUTH OR CONSEQUENCES NM
87901-3331
US

IV. Provider business mailing address

455 S FOCH ST
TRUTH OR CONSEQUENCES NM
87901-3331
US

V. Phone/Fax

Practice location:
  • Phone: 575-647-8366
  • Fax: 575-647-8381
Mailing address:
  • Phone: 575-647-8366
  • Fax: 575-647-8381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2002-0475
License Number StateNM

VIII. Authorized Official

Name: DR. HARUHUANI SPRUCE
Title or Position: OWNER
Credential: M.D.
Phone: 575-740-1717