MEDICARE: MRS. MARY ANN MCGUIRE CFNP

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
1	207Q00000X	Family Medicine Physician	R38408	NM

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	110162385	OTHER		RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	79619	OTHER	NM	PRESBYTERIAN
3	MARYANNMCGUIRE	OTHER		TRICARE
5	87726	OTHER		UNITED HEALTH CARE
6	841627609	OTHER		HEALTHSMART
7	NM011928	OTHER	NM	BCBS

General Provider Information

NPI Number	:	1417958711
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY ANN MCGUIRE CFNP

Provider Business Mailing Address
First Line	:	1717 W 2ND ST
Second Line	:	STE 101
City	:	ROSWELL
State	:	NM
Zip	:	88201-2000
Country	:	US
Telephone Number	:	575-627-1200
Fax Number	:	888-445-1844

Provider Business Practice Location Address
First Line	:	1627 S UNION AVE
Second Line	:
City	:	ROSWELL
State	:	NM
Zip	:	88203-2656
Country	:	US
Telephone Number	:	575-208-0106
Fax Number	:	575-208-0700

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	03/22/2018

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