Organization
MAIN STREET MEDICAL CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JESSICA L CROSS FNP-BC (OWNER)
(575) 754-6330
Entity
Organization
Contact information
Practice address
105 E MAIN STREET, RED RIVER, NM 87558-0010
(575) 754-6330
(575) 754-6232
Mailing address
PO BOX 10, RED RIVER, NM 87558-0010
(575) 779-8015
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
—
—
363LF0000X
Family Nurse Practitioner
Primary
CNP-01822
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1225389919
ORG 2 NPI
NM
Enumeration date
09/21/2012
Last updated
07/15/2025
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