Organization Name: | ULTIMED RED RIVER, INC. |
NPI Number: | 1962719765 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | LESA D FRAKER (PRESIDENT) |
Mailing Address: | 200a Pioneer Rd Red River |
State: | NM US |
Postal Code: | 87558 |
Phone Number: | 5757541773 |
Fax Number: | |
NPI Enumeration Date: | 09/01/2010 |
NPI Last Update Date: | 12/14/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QU0200X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Urgent Care |
Taxonomy Definition: |