Provider Demographics
NPI:1447430509
Name:ROSWELL EAR, NOSE & THROAT & ALLERGY L. L. C.
Entity Type:Organization
Organization Name:ROSWELL EAR, NOSE & THROAT & ALLERGY L. L. C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:HOBBS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-622-2911
Mailing Address - Street 1:342 SHERRILL LN STE A
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5831
Mailing Address - Country:US
Mailing Address - Phone:575-622-2911
Mailing Address - Fax:575-622-2598
Practice Address - Street 1:342 SHERRILL LN STE A
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5831
Practice Address - Country:US
Practice Address - Phone:575-622-2911
Practice Address - Fax:575-622-2598
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCS00208445174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM90859561OtherMEDICAID
NMNM009D18OtherBCBS OF NEW MEXICO
NM400521137Medicare PIN