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General NPI Number Information
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NPI Number | 1174231484
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Entity Type | Organization
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Legal Business Name | ROSWELL INFUSIONS LLC
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 313 W COUNTRY CLUB RD STE 9
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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 | 575-347-1883
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 102
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City | ROSWELL
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State | NM
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Zip | 88202-0102
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Country | US
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Telephone | 575-347-1883
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PRESTON KING
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Credential | DNP, CRNA.
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Telephone | 573-429-1313
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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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 | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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