institution
Main Street Medical Center, Llc
Family Nurse Practitioner in Red River, New Mexico
NPI 1225389919

Main Street Medical Center, Llc is a Family Nurse Practitioner based in Red River, NM and is specialized in Family. Main Street Medical Center, Llc practices in Red River, NM. The NPI Number for Main Street Medical Center, Llc is 1225389919 and holds a License No. (New Mexico).

The current practice location address for Main Street Medical Center, Llc is 200 Pioneer Rd, Red River, NM and can be reached out via phone at 575-754-6330 and via fax at 575-754-6232.

Location: 200 Pioneer Rd, Red River, NM, 87558-0010
institution
Provider Profile Details
NPI Number
1225389919
Provider Name
Main Street Medical Center, Llc
Credential
Provider Entity Type
Organization
Address
200 Pioneer Rd, Red River, NM, 87558-0010
Phone Number
575-754-6330
Fax Number
575-754-6232
Provider Enumeration Date
09/21/2012
Last Update Date
03/12/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
1225389919 01 NM ORG 2 NPI
institution
Provider Business Practice Location Address Details
Address
200 Pioneer Rd
City
State
Zip
87558-0010
Phone Number
575-754-6330
Fax Number
575-754-6232
person
Provider Business Mailing Address Details
Address
200 Pioneer Rd
City
State
Zip
87558-0010
Phone Number
575-754-6330
Fax Number
575-754-6232
person
Provider's Taxonomy Details 1
Type
Ambulatory Health Care Facilities
Classification
Clinic/Center
Speciality
Primary Care
Taxonomy
License No.
CNP-01822 (New Mexico)
Definition
Definition to come...
person
Provider's Taxonomy Details 2
Type
Physician Assistants & Advanced Practice Nursing Providers
Classification
Nurse Practitioner
Speciality
Family
Taxonomy
License No.
()
Definition
Definition to come...
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