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General NPI Number Information
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NPI Number | 1578015012
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Entity Type | Organization
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Legal Business Name | PANGEA MEDICAL GLOBUS
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Dates
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Enumeration Date | 11/01/2016
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Last Update Date | 01/10/2019
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Provider Practice Location Address
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Address Line | 1700 N UNION AVE
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City | ROSWELL
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State | NM
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Zip | 88201-3267
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Country | US
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Telephone | 575-208-0224
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Fax | 575-616-5626
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Provider Business Mailing Address
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Address Line | PO BOX 8244
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City | ROSWELL
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State | NM
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Zip | 88202-8244
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Country | US
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Telephone | 575-208-0224
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Fax | 575-616-5562
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Authorized Official
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Title or Position | CFO
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Name | JEFF MCWHORTER
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Credential | CPA
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Telephone | 575-779-1007
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD-2011-0547
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License Number State | NM
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | MD-2011-0547
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License Number State | NM
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