Healthcare Provider Details

I. General information

NPI: 1619045796
Provider Name (Legal Business Name): MEDICAL SERVICES NETWORK PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 MESQUITE
TUCUMCARI NM
88401-4617
US

IV. Provider business mailing address

714 MESQUITE
TUCUMCARI NM
88401-4617
US

V. Phone/Fax

Practice location:
  • Phone: 505-461-4434
  • Fax: 505-461-4435
Mailing address:
  • Phone: 505-461-4434
  • Fax: 505-461-4435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: DAVID LAZARUS
Title or Position: OWNER
Credential: CRNA
Phone: 505-461-4434