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General NPI Number Information
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NPI Number | 1700393782
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Entity Type | Organization
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Legal Business Name | MCLEOD MEDICAL CENTERS OF NM, INC.
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Dates
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Enumeration Date | 12/29/2017
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 12127B HWY 14 N STE 5
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City | CEDAR CREST
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State | NM
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Zip | 87008-9499
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Country | US
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Telephone | 505-281-5180
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Fax | 505-281-5320
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Provider Business Mailing Address
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Address Line | 12127B HWY 14 N STE 5
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City | CEDAR CREST
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State | NM
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Zip | 87008-9499
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Country | US
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Telephone | 505-281-5180
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Fax | 505-281-5320
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | CHRISTINA G. MARRUFO
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Credential |
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Telephone | 505-916-6544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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