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NPI Code Detail

MEDICARE: MICHAEL J ROURKE LISW

MEDICARE: MICHAEL J ROURKE LISW
Medicare Provider Information

Scope of Practice

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

# Taxonomy Code Taxonomy License Number License Number State
1104100000XSocial WorkerI-3206NM

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1295830461
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL J ROURKE LISW
Provider Business Mailing Address
First Line : PO BOX 16667
Second Line :
City : LAS CRUCES
State : NM
Zip : 88004-6667
Country : US
Telephone Number : 505-644-8846
Fax Number : 505-522-5717
Provider Business Practice Location Address
First Line : 3751 DEL REY BLVD
Second Line :
City : LAS CRUCES
State : NM
Zip : 88012-7710
Country : US
Telephone Number : 505-644-8846
Fax Number : 505-522-5717
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/13/2006
Last Update Date : 07/08/2007

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Directions to “ MICHAEL J ROURKE LISW” Practice Location

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