Organization
EASTERN PLAINS MEDICAL GROUP, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS C NICHOLSON M.D. (PRESIDENT)
(505) 622-7593
Entity
Organization
Contact information
Practice address
350 W COUNTRY CLUB RD, SUITE 205, ROSWELL, NM 88201-5205
(505) 622-7593
(505) 622-5538
Mailing address
350 W COUNTRY CLUB RD, SUITE 205, ROSWELL, NM 88201-5205
(505) 622-7593
(505) 622-5538
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
89-82
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P5116
—
NM
Enumeration date
10/02/2006
Last updated
08/22/2020
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