# SIEVERS SPORTS MEDICINE INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366631616
- **Authorized official:** DR. JOEL WILLIAM SIEVERS M.D. (PRESIDENT/DIRECTOR)
- **Authorized official phone:** (575) 226-3023

## Contact information

- **Practice address:** 304 S MAIN AVE, PORTALES, NM 88130-6218
- **Practice address phone:** (575) 226-3023
- **Practice address fax:** (575) 226-3024
- **Mailing address:** PO BOX 55, PORTALES, NM 88130-0055
- **Mailing address phone:** (575) 226-3023
- **Mailing address fax:** (575) 226-3024

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207QS0010X | Sports Medicine (Family Medicine) Physician | 2002-0109 | NM | Yes |

## Other

- **Enumeration date:** 10/22/2007
- **Last updated:** 03/12/2008