Provider Demographics
NPI:1124213384
Name:SPROKET MEDICAL MANAGEMET
Entity Type:Organization
Organization Name:SPROKET MEDICAL MANAGEMET
Other - Org Name:CENTER FOR INDUSTRIAL MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TOBY
Authorized Official - Middle Name:
Authorized Official - Last Name:HERRING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-492-9675
Mailing Address - Street 1:2430 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3553
Mailing Address - Country:US
Mailing Address - Phone:505-628-0926
Mailing Address - Fax:505-628-0493
Practice Address - Street 1:1900 N DAL PASO ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-3045
Practice Address - Country:US
Practice Address - Phone:505-492-9675
Practice Address - Fax:505-397-0282
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SPROCKET MEDICAL MANAGEMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-09-11
Last Update Date:2008-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTIN