Provider Demographics
NPI:1073047825
Name:NEW MEXICO SPECIALTY MEDICAL SERVICES, LLC
Entity Type:Organization
Organization Name:NEW MEXICO SPECIALTY MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:MICHELLE
Authorized Official - Last Name:SHELBY
Authorized Official - Suffix:
Authorized Official - Credentials:ARNP
Authorized Official - Phone:772-708-6776
Mailing Address - Street 1:8613 SNOWY OWL WAY
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3416
Mailing Address - Country:US
Mailing Address - Phone:772-708-6776
Mailing Address - Fax:888-731-3365
Practice Address - Street 1:2004 GUN CLUB RD SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87105-6411
Practice Address - Country:US
Practice Address - Phone:772-708-6776
Practice Address - Fax:888-731-3365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-19
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty