Provider Demographics
NPI:1396405528
Name:MEDNM URGENT CARE
Entity Type:Organization
Organization Name:MEDNM URGENT CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:ALI
Authorized Official - Middle Name:M
Authorized Official - Last Name:SHERIF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-390-1383
Mailing Address - Street 1:3305 N GRIMES ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-1219
Mailing Address - Country:US
Mailing Address - Phone:575-392-1503
Mailing Address - Fax:575-392-3555
Practice Address - Street 1:3305 N GRIMES ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-1219
Practice Address - Country:US
Practice Address - Phone:575-392-1503
Practice Address - Fax:575-392-3555
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMMD2010-0190OtherLICENSE NM