Organization Name: | ISPM - NEW MEXICO LLC |
NPI Number: | 1861633307 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | ROBIN JAMES FOWLER (OWNER) |
Mailing Address: | 2539 Medical Dr Ste 108 Alamogordo |
State: | NM US |
Postal Code: | 883108720 |
Phone Number: | 5754373860 |
Fax Number: | 5754370358 |
NPI Enumeration Date: | 03/12/2009 |
NPI Last Update Date: | 10/04/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | MD2009-0017 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NM |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |