| Immedicare Care Clinic Pc | |
|
721 Mechem Dr Sierra Mall Ruidoso NM 88345-6911 | |
| (505) 630-5300 | |
| (505) 630-5301 |
| Full Name | Immedicare Care Clinic Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 721 Mechem Dr, Ruidoso, New Mexico |
| Authorized Official Name and Position | Marilyn Nishitani (OWNER) |
| Authorized Official Contact | 5056305300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Immedicare Care Clinic Pc 721 Mechem Dr Sierra Mall Ruidoso NM 88345-6911 Ph: (505) 630-5300 | Immedicare Care Clinic Pc 721 Mechem Dr Sierra Mall Ruidoso NM 88345-6911 Ph: (505) 630-5300 |
| NPI Number | 1942292149 |
|---|---|
| Provider Enumeration Date | 08/16/2005 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1942292149 | NPI | - | NPPES |
| 36888257 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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