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General NPI Number Information
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NPI Number | 1093935355
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Entity Type | Organization
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Legal Business Name | UNION COUNTY MEDICAL CENTER INC
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Dates
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Enumeration Date | 04/27/2007
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Last Update Date | 07/01/2009
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Provider Practice Location Address
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Address Line | 314 N. 3RD AVE
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City | CLAYTON
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State | NM
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Zip | 88415-0565
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Country | US
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Telephone | 575-374-8313
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Fax | 575-374-2064
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Provider Business Mailing Address
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Address Line | 314 N. 3RD AVE
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City | CLAYTON
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State | NM
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Zip | 88415-0565
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Country | US
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Telephone | 575-374-8313
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Fax | 575-374-2064
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. LORI VAN WORMER
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Credential |
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Telephone | 575-374-8313
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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 | 6239
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License Number State | NM
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