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General NPI Number Information
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NPI Number | 1750490017
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Entity Type | Organization
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Legal Business Name | TALL PINES MEDICAL INC
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 02/16/2012
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Provider Practice Location Address
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Address Line | 714 MECHEM DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6905
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Country | US
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Telephone | 575-257-4061
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Fax | 575-257-4445
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Provider Business Mailing Address
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Address Line | 714 MECHEM DR
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City | RUIDOSO
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State | NM
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Zip | 88345-6905
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Country | US
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Telephone | 575-257-4061
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Fax | 575-257-4445
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | ANN SPENCE
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Credential |
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Telephone | 575-257-4061
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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 | 88-74
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License Number State | NM
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