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General NPI Number Information
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NPI Number | 1114977675
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Entity Type | Organization
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Legal Business Name | EASTERN NEW MEXICO PHYSICIANS AND SURGEONS LLC
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 05/12/2008
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Provider Practice Location Address
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Address Line | 2425 W 21ST STREET
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 505-763-9800
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Fax | 505-769-1998
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Provider Business Mailing Address
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Address Line | 2425 W 21ST STREET
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City | CLOVIS
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State | NM
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Zip | 88101
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Country | US
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Telephone | 505-763-9800
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Fax | 505-769-1998
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | LONNIE J RAY
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Credential |
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Telephone | 505-763-9800
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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 |
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License Number State |
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