| Organization Name: | COMPCARE NEW MEXICO INC. |
| NPI Number: | 1033444658 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | LISA GURULE (CREDENTIALING SPECIALIST) |
| Mailing Address: | 706 La Joya St Ste C Espanola |
| State: | NM US |
| Postal Code: | 875322877 |
| Phone Number: | 5053673547 |
| Fax Number: | |
| NPI Enumeration Date: | 10/15/2009 |
| NPI Last Update Date: | 10/23/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QU0200X |
| License Number: | R25973 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NM |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Urgent Care |
| Taxonomy Definition: | |