Organization
FOUR CORNERS AMBULATORY SURGERY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CHARLES REDWING FACMPE (EXECUTIVE DIRECTOR)
(505) 564-2300
Entity
Organization
Contact information
Practice address
2300 E 30TH ST BLDG A, FARMINGTON, NM 87401-8991
(505) 564-2300
(505) 564-2210
Mailing address
2300 E 30TH ST BLDG A, FARMINGTON, NM 87401-8991
(505) 564-2300
(505) 564-2210
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
6701
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
S7971
—
NM
Enumeration date
11/20/2006
Last updated
04/08/2010
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