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Organization
ROSWELL CLINIC CORP
Active
Organization
ROSWELL CLINIC CORP
Active
Parent organization
ROSWELL CLINIC CORP
Organization subpart
Yes
Provider details
NPI number
Legal business name
ROSWELL CLINIC CORP
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR, ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
350 W COUNTRY CLUB RD, STE 201, ROSWELL, NM 88201-5205
(888) 801-5554
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
NM
207R00000X
Internal Medicine Physician
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
207RP1001X
Pulmonary Disease Physician
—
—
207RS0012X
Sleep Medicine (Internal Medicine) Physician
—
—
207V00000X
Obstetrics & Gynecology Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
60806516
—
NM
01
—
DA5509
RR MEDICARE
NM
01
—
DD5451
RR MEDICARE
NM
01
—
NPI AND TIN
BCBS
NM
Enumeration date
10/04/2005
Last updated
01/25/2022
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