MEDICARE: ROSWELL INFUSIONS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	367500000X	Certified Registered Nurse Anesthetist
2	104100000X	Social Worker
3	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1174231484
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROSWELL INFUSIONS LLC

Provider Business Mailing Address
First Line	:	PO BOX 102
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88202-0102
Country	:	US
Telephone Number	:	575-347-1883
Fax Number	:

Provider Business Practice Location Address
First Line	:	300 S LEA AVE # 4
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-4562
Country	:	US
Telephone Number	:	575-347-1883
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	PRESTON KING
Credential	:	DNP, CRNA.
Telephone Number	:	573-429-1313

Provider Enumeration Date	:	11/07/2022
Last Update Date	:	03/05/2026

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Directions to “ROSWELL INFUSIONS LLC ” Practice Location

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