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General NPI Number Information
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NPI Number | 1063953768
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Entity Type | Organization
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Legal Business Name | SHERIDAN CHILDRENS HEALTHCARE SERVICES OF NEW MEXICO INC
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Dates
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Enumeration Date | 03/14/2017
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Last Update Date | 03/14/2017
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Provider Practice Location Address
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Address Line | 117 E 19TH ST
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City | ROSWELL
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State | NM
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Zip | 88201-5151
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Country | US
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Telephone | 954-838-2371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 743946
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City | ATLANTA
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State | GA
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Zip | 30374-3946
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Country | US
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Telephone | 954-838-2371
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ROBERTO COWARD
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Credential |
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Telephone | 954-838-2371
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080N0001X
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Taxonomy Name | Neonatal-Perinatal Medicine Physician
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License Number |
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License Number State |
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