Organization
ROSWELL CLINIC CORP
Active
Other names
Ponderossa Medical Associates
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR DIRECTOR, PROVIDER ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
300 W COUNTRY CLUB RD STE 230, ROSWELL, NM 88201-5240
(575) 622-1411
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7385
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Enumeration date
02/24/2023
Last updated
02/24/2023
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