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General NPI Number Information
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NPI Number | 1679644728
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Entity Type | Organization
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Legal Business Name | ENT ASSOCIATES OF SOUTHEASTERN NEW MEXICO
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Dates
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Enumeration Date | 11/12/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 5419 N LOVINGTON HWY
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City | HOBBS
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State | NM
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Zip | 88240-9131
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Country | US
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Telephone | 505-392-0495
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Fax | 505-392-0562
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Provider Business Mailing Address
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Address Line | PO BOX 2484
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City | HOBBS
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State | NM
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Zip | 88241-2484
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Country | US
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Telephone | 505-392-0495
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Fax | 505-392-0562
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GEORGE J FARRELL III
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Credential | MD
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Telephone | 505-392-0495
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 2002-0332
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License Number State | NM
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