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General NPI Number Information
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NPI Number | 1417870049
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Entity Type | Organization
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Legal Business Name | RIO RANCHO MEDICAL & INFUSION CARE
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Dates
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Enumeration Date | 07/31/2026
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Last Update Date | 07/31/2026
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Provider Practice Location Address
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Address Line | 1713 WELLSPRING AVE SE
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City | RIO RANCHO
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State | NM
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Zip | 87124-5106
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Country | US
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Telephone | 505-254-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 6980 OBANNON DR
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City | LAS VEGAS
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State | NV
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Zip | 89117-2122
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Country | US
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Telephone | 702-659-8925
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DEMETRIUS WARE
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Credential |
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Telephone | 702-659-8925
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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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 | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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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 | 207RA0201X
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Taxonomy Name | Allergy & Immunology (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 207RP1002X
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Taxonomy Name | Physician Nutrition Specialist (Internal Medicine)
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #7
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Taxonomy Code | 207SG0201X
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Taxonomy Name | Clinical Genetics (M.D.) Physician
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License Number |
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License Number State |
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