Organization
EASTERN NEW MEXICO PHYSICIANS AND SURGEONS LLC
Active
Organization
EASTERN NEW MEXICO PHYSICIANS AND SURGEONS LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
LONNIE J RAY (PRACTICE ADMINISTRATOR)
(505) 763-9800
Entity
Organization
Contact information
Practice address
2425 W 21ST STREET, CLOVIS, NM 88101
(505) 763-9800
(505) 769-1998
Mailing address
2425 W 21ST STREET, CLOVIS, NM 88101
(505) 763-9800
(505) 769-1998
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00NM001B06
BCBS OF NM
NM
01
—
03-07242-6000
CRS-1 NUMBER
NM
05
—
78904374
—
NM
01
—
DF1773
RAILROAD MEDICARE PIN
NM
Enumeration date
05/12/2006
Last updated
05/12/2008
Update your record
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