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General NPI Number Information
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NPI Number | 1053628552
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Entity Type | Organization
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Legal Business Name | SACRAMENTO ORTHOPAEDICS, LLC
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 09/03/2010
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Provider Practice Location Address
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Address Line | 2301 INDIAN WELLS RD SUITE A
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City | ALAMOGORDO
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State | NM
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Zip | 88310-4611
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Country | US
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Telephone | 575-434-0639
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Fax | 575-434-4148
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Provider Business Mailing Address
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Address Line | 2301 INDIAN WELLS RD SUITE A
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City | ALAMOGORDO
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State | NM
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Zip | 88310-4611
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Country | US
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Telephone | 575-434-0639
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Fax | 575-434-4148
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHARLES MARK RACE
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Credential | M.D.
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Telephone | 575-434-0639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | MD209-0724
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License Number State | NM
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