Provider Demographics
NPI:1083891030
Name:RIO PECOS FAMILY PRACTICE OF LINCOLN COUNTY INC.
Entity Type:Organization
Organization Name:RIO PECOS FAMILY PRACTICE OF LINCOLN COUNTY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEIDEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-257-3681
Mailing Address - Street 1:159 MESCALERO TRL
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88345-6089
Mailing Address - Country:US
Mailing Address - Phone:505-257-3681
Mailing Address - Fax:505-257-4036
Practice Address - Street 1:159 MESCALERO TRL
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6089
Practice Address - Country:US
Practice Address - Phone:505-257-3681
Practice Address - Fax:505-257-4036
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty