Organization
NORTHERN NEW MEXICO SURGICAL SERVICES PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JACQUE CALLIS (CREDENTIALING ASSISTANT)
(575) 207-8890
Entity
Organization
Contact information
Practice address
300 WILSON ST, CLAYTON, NM 88415-3304
(575) 374-0021
Mailing address
PO BOX 545, CLAYTON, NM 88415-0545
(575) 374-0021
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD2013-0738
NM
Other
Enumeration date
12/09/2014
Last updated
01/22/2015
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