=====================================================
General NPI Number Information
=====================================================
NPI Number | 1235231549
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CRIT HOBBS MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/05/2006
-----------------------------------------------------
Last Update Date | 01/10/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 313 W COUNTRY CLUB RD STE 15
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88201-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-623-8021
-----------------------------------------------------
Fax | 575-623-0193
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 313 W COUNTRY CLUB RD STE 15
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88201-5804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-623-8021
-----------------------------------------------------
Fax | 575-623-0193
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JOANN HOBBS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-623-8021
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 78-180
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------