Provider Demographics
NPI:1073710547
Name:WOMEN'S REPRODUCTIVE CLINIC OF NEW MEXIC O, LLC
Entity Type:Organization
Organization Name:WOMEN'S REPRODUCTIVE CLINIC OF NEW MEXIC O, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANZ
Authorized Official - Middle Name:C
Authorized Official - Last Name:THEARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-589-3855
Mailing Address - Street 1:5690 SANTA TERESITA
Mailing Address - Street 2:
Mailing Address - City:SUNLAND PARK
Mailing Address - State:NM
Mailing Address - Zip Code:88063
Mailing Address - Country:US
Mailing Address - Phone:505-589-3855
Mailing Address - Fax:
Practice Address - Street 1:5690 SANTA TERESITA
Practice Address - Street 2:
Practice Address - City:SUNLAND PARK
Practice Address - State:NM
Practice Address - Zip Code:88063
Practice Address - Country:US
Practice Address - Phone:505-589-3855
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM79-288261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center