Organization
BLOOM NEW MEXICO LLC
Active
Other names
American Family Care
Organization subpart
No
Provider details
NPI number
Authorized official
SPENCER SMITH (CEO)
(970) 565-1919
Entity
Organization
Contact information
Practice address
2930 E MAIN ST, FARMINGTON, NM 87402-7624
(505) 326-6000
Mailing address
50 HENRY ST, CORTEZ, CO 81321-3012
Taxonomy
Speciality
Code
Description
License number
State
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
261QU0200X
Urgent Care Clinic/Center
—
—
Other
Enumeration date
06/25/2019
Last updated
05/06/2020
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