MEDICARE: SILVER ALTERNATIVE MEDICINE, P.A.

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	171100000X	Acupuncturist	337RX1	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	NM00R57J	OTHER	NM	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1629148473
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SILVER ALTERNATIVE MEDICINE, P.A.

Provider Business Mailing Address
First Line	:	1301 NO. VIRGINIA ST.
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4617
Country	:	US
Telephone Number	:	505-388-8858
Fax Number	:	575-388-8858

Provider Business Practice Location Address
First Line	:	506 W. 13TH ST.
Second Line	:
City	:	SILVER CITY
State	:	NM
Zip	:	88061-4617
Country	:	US
Telephone Number	:	505-388-8858
Fax Number	:	505-388-8858

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PAUL HOWARD STUETZER
Credential	:	D.O.M.
Telephone Number	:	505-388-8858

Provider Enumeration Date	:	11/09/2006
Last Update Date	:	07/30/2008

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