Provider Demographics
NPI:1053629089
Name:OMS OF SE NM, LLC
Entity Type:Organization
Organization Name:OMS OF SE NM, LLC
Other - Org Name:OMS OF SE NM, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:ECKEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-623-5711
Mailing Address - Street 1:207 N. UNION STE. E
Mailing Address - Street 2:OMS OF SE NM, LLC
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3068
Mailing Address - Country:US
Mailing Address - Phone:575-623-5711
Mailing Address - Fax:575-623-8628
Practice Address - Street 1:207 N. UNION STE. E
Practice Address - Street 2:OMS OF SE NM, LLC
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3068
Practice Address - Country:US
Practice Address - Phone:575-623-5711
Practice Address - Fax:575-623-8628
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OMS OF SE NM, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-09-24
Last Update Date:2010-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty