Main Street Medical Center, Llc
Main Street Medical Center, Llc is a health care provider in Red River, NM. In this page you will find its mailing address, practice location, phone number, specialty etc.
|Practice Location|| 305 Pioneer Rd, Ste A, Red River, NM 87558-0010, US |
|Practice Location Phone||575-754-6330|
|Practice Location Fax||575-754-6232|
|Legal Business Name||MAIN STREET MEDICAL CENTER, LLC|
|Enumeration Date ? ||Sep 21, 2012|
|Last Update Date ? ||Feb 5, 2018|
NPI: National Provider Identifier issued to health care providers by Centers for Medicare and Medicaid Services (CMS).
Specialties & Licenses of Main Street Medical Center, Llc
|Specialty||Provider Type||Specialization||License||License State|
|Clinic/Center||Ambulatory Health Care Facilities||Primary Care |
|Nurse Practitioner||Physician Assistants & Advanced Practice Nursing Providers||Family ||CNP-01822||New Mexico|
Legacy Provider IDs of Main Street Medical Center, Llc
|Provider Id||Issuer State||Issuer Type||Issuer|
|1225389919||New Mexico||Other||ORG 2 NPI|
Authorized Official of Main Street Medical Center, Llc
An authorized official is an appointed official with the legal authority to make changes and/or updates to the Main Street Medical Center, Llc's status and to commit the provider to fully abide by the laws and regulations relating to the National Provider Identifier (NPI).
|Authorized Official || Jessica L Cross (FNP-BC)|
|Authorized Official Title/Position||OWNER|
|Authorized Official Phone Number||575-754-6330|