Organization
EASTERN MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGIE PARKS (PRACTICE ADMINISTRATOR)
(575) 356-6653
Entity
Organization
Contact information
Practice address
42121 US HWY 70, PORTALES, NM 88130-9357
(575) 356-6652
(575) 359-6827
Mailing address
PO BOX 510, 42121 US HWY 70, PORTALES, NM 88130-0510
(575) 356-6652
(575) 359-6827
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1144264805
NPI
—
01
—
1477505477
NPI
—
01
—
1538103197
NPI
—
01
—
1568405587
NPI
—
Enumeration date
07/07/2006
Last updated
07/15/2008
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