Organization
COUNTY LINE MEDICAL SERVICE INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KYONG YOL KO MD (MD / PRESIDENT)
(575) 824-5007
Entity
Organization
Contact information
Practice address
545 S COUNTY LINE DR SPC A, CHAPARRAL, NM 88081-7802
(575) 824-5007
Mailing address
545 S COUNTY LINE DR SPC A, CHAPARRAL, NM 88081-7802
(575) 824-5007
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40725391
—
NM
01
—
DF0606
RR MEDICARE
—
Enumeration date
07/04/2006
Last updated
12/10/2013
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