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General NPI Number Information
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NPI Number | 1073710547
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Entity Type | Organization
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Legal Business Name | WOMEN'S REPRODUCTIVE CLINIC OF NEW MEXIC O, LLC
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Dates
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Enumeration Date | 06/28/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5690 SANTA TERESITA
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City | SUNLAND PARK
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State | NM
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Zip | 88063
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Country | US
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Telephone | 505-589-3855
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Fax |
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Provider Business Mailing Address
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Address Line | 5690 SANTA TERESITA
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City | SUNLAND PARK
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State | NM
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Zip | 88063
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Country | US
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Telephone | 505-589-3855
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. FRANZ C. THEARD
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Credential | M.D.
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Telephone | 505-589-3855
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 79-288
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License Number State | NM
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