Organization
COUNTRY MEDICAL SERVICES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. DIANA LOUISE LEWIS NP-C (OWNER OF BUSINESS/ NP-C PROVIDER)
(575) 666-2475
Entity
Organization
Contact information
Practice address
NM STATE HIGHWAY 120, #1252 (FYI RURAL ADDRESS), POB 203, OCATE, NM 87734-0203
(575) 666-2475
Mailing address
# 1252, NM STATE HIGHWAY 120 (FYI RURAL ADDRESS), POB 203, OCATE, NM 87734-0203
(575) 666-2475
(800) 560-1129
Taxonomy
Speciality
Code
Description
License number
State
364SF0001X
Family Health Clinical Nurse Specialist
Primary
R24775
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
22002570
—
NM
Enumeration date
11/21/2008
Last updated
10/22/2011
Update your record
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