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General NPI Number Information
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NPI Number | 1144956533
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Entity Type | Organization
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Legal Business Name | PRIORITY MEDICAL AND HEALTH SERVICES LLC
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Dates
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Enumeration Date | 07/27/2022
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Last Update Date | 11/05/2024
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Provider Practice Location Address
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Address Line | 313 W COUNTRY CLUB RD STE 6
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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 | 575-291-1110
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Fax | 575-205-4165
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Provider Business Mailing Address
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Address Line | PO BOX 8244
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City | ROSWELL
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State | NM
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Zip | 88202-8244
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Country | US
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Telephone | 575-291-1110
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Fax | 575-205-4165
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Authorized Official
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Title or Position | OWNER
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Name | RUBEN ALFARO SUPAN
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Credential | CNP
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Telephone | 505-409-0831
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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