=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730172735
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MUGLIN LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/24/2005
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 711 W ALAMEDA ST
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88203-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-623-4448
-----------------------------------------------------
Fax | 505-623-9571
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 711 W ALAMEDA ST
-----------------------------------------------------
City | ROSWELL
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88203-4403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-623-4448
-----------------------------------------------------
Fax | 505-623-9571
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DIRECT OWNER
-----------------------------------------------------
Name | DR. MARGARET V DENTON
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 505-623-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207R00000X
-----------------------------------------------------
Taxonomy Name | Internal Medicine Physician
-----------------------------------------------------
License Number | 97218
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------