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General NPI Number Information
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NPI Number | 1104179175
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Entity Type | Organization
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Legal Business Name | SUNBELT OASIS EMERGENCY PHYSICIANS, LLC
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Dates
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Enumeration Date | 10/16/2012
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Last Update Date | 08/12/2019
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Provider Practice Location Address
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Address Line | 42121 US HWY 70
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City | PORTALES
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State | NM
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Zip | 88130
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Country | US
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Telephone | 575-359-1800
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Fax | 575-356-9210
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Provider Business Mailing Address
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Address Line | P.O. BOX 98729
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City | LAS VEGAS
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State | NV
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Zip | 89193-8729
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Country | US
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Telephone | 800-444-7009
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Fax | 800-305-3233
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Authorized Official
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Title or Position | OFFICER
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Name | KATHY KONDAS
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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