Provider Demographics
NPI:1033197538
Name:ENGLAND, SIDNEY CLYDE (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SIDNEY
Middle Name:CLYDE
Last Name:ENGLAND
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1574
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1574
Mailing Address - Country:US
Mailing Address - Phone:575-627-9110
Mailing Address - Fax:575-627-4127
Practice Address - Street 1:402 W COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5247
Practice Address - Country:US
Practice Address - Phone:575-627-9500
Practice Address - Fax:575-627-9535
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2014-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA01205363AM0700X
NMPA2013-0094363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ2565OtherMCD GROUP KYMERA
NMPA2013-0094OtherNM PROVIDER LICENSE
NM800521089OtherMCR GROUP KYMERA
NM1932187044OtherGROUP NPI
TXPA01205OtherTX LICENSE NUMBER
NM343838YL09Medicare PIN