Organization
RIO GRANDE EMERGENCY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KELLY WILLOUGHBY (CREDENTIALING)
(706) 354-5770
Entity
Organization
Contact information
Practice address
2450 S TELSHOR BLVD, LAS CRUCES, NM 88011-5069
(706) 354-5770
(706) 354-5769
Mailing address
PO BOX 5719, ATHENS, GA 30604-5719
(706) 354-5770
(706) 354-5769
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
78138701
—
NM
Enumeration date
09/16/2006
Last updated
09/02/2011
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