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General NPI Number Information
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NPI Number | 1083891030
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Entity Type | Organization
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Legal Business Name | RIO PECOS FAMILY PRACTICE OF LINCOLN COUNTY INC.
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 06/16/2008
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Provider Practice Location Address
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Address Line | 159 MESCALERO TRL
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City | RUIDOSO
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State | NM
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Zip | 88345-6089
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Country | US
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Telephone | 505-257-3681
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Fax | 505-257-4036
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Provider Business Mailing Address
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Address Line | 159 MESCALERO TRL
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City | RUIDOSO
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State | NM
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Zip | 88345-6089
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Country | US
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Telephone | 505-257-3681
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Fax | 505-257-4036
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. BRENDA L SEIDEL
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Credential |
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Telephone | 505-257-3681
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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