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General NPI Number Information
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NPI Number | 1558265587
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Entity Type | Organization
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Legal Business Name | SIMPLICITY HEALTH OF NEW MEXICO
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Dates
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Enumeration Date | 10/05/2026
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Last Update Date | 10/05/2026
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Provider Practice Location Address
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Address Line | 1200 N WHITE SANDS BLVD STE 110A
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6774
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Country | US
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Telephone | 575-488-0030
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Fax | 575-488-0032
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Provider Business Mailing Address
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Address Line | 1200 N WHITE SANDS BLVD STE 110A
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City | ALAMOGORDO
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State | NM
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Zip | 88310-6774
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Country | US
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Telephone | 575-488-0030
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Fax | 575-488-0032
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JEREMY FULTZ
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Credential |
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Telephone | 575-488-0030
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QD0401X
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Taxonomy Name | Diabetology (Family Medicine) Physician
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License Number |
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License Number State | NULL
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