# TAOS SPORTS MEDICINE SRVS LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Taos MRI
- **Organization subpart:** No

## Provider details

- **NPI number:** 1225069230
- **Authorized official:** JOCELYN LUCERO (OFFICE MANAGER)
- **Authorized official phone:** (505) 737-0304

## Contact information

- **Practice address:** 1398 WEIMER RD, STE 203, TAOS, NM 87571
- **Practice address phone:** (505) 737-0304
- **Practice address fax:** (505) 737-0383
- **Mailing address:** 1398 WEIMER RD, ST 203, TAOS, NM 87571
- **Mailing address phone:** (505) 737-0304
- **Mailing address fax:** (505) 737-0383

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | NULL | Yes |
| 208100000X | Physical Medicine & Rehabilitation Physician | — | — | Yes |
| 2085R0202X | Diagnostic Radiology Physician | NM3072 | NM | — |

## Other

- **Enumeration date:** 07/06/2006
- **Last updated:** 10/16/2007