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General NPI Number Information
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NPI Number | 1104241173
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Entity Type | Organization
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Legal Business Name | PEARSON HEART CLINIC, LLC
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Dates
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Enumeration Date | 02/26/2014
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Last Update Date | 06/20/2018
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Provider Practice Location Address
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Address Line | 313 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5804
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Country | US
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Telephone | 575-625-8430
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Fax |
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Provider Business Mailing Address
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Address Line | 1621 N WASHINGTON AVE
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City | ROSWELL
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State | NM
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Zip | 88201-3272
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Country | US
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Telephone | 575-625-8430
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CLARENCE E PEARSON, MD
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Credential |
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Telephone | 575-625-8452
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | 2003-0352
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License Number State | NM
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