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General NPI Number Information
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NPI Number | 1437804408
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Entity Type | Organization
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Legal Business Name | ZIA MEDICAL GROUP LLC
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Dates
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Enumeration Date | 02/17/2022
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Last Update Date | 02/17/2022
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Provider Practice Location Address
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Address Line | 233 FAIRWAY TER N STE B
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City | CLOVIS
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State | NM
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Zip | 88101-3060
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Country | US
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Telephone | 575-762-7779
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Fax | 575-762-3526
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Provider Business Mailing Address
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Address Line | PO BOX 5032
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City | CLOVIS
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State | NM
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Zip | 88102-5032
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Country | US
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Telephone | 575-762-7779
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Fax | 575-762-3526
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Authorized Official
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Title or Position | MANAGER
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Name | AHMAD OTHMAN
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Credential | MD
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Telephone | 312-813-6958
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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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 | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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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 | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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