Provider Demographics
NPI:1487853149
Name:PECOS VALLEY OF NEW MEXICO, LLC
Entity Type:Organization
Organization Name:PECOS VALLEY OF NEW MEXICO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:T
Authorized Official - Last Name:BREWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-892-9813
Mailing Address - Street 1:5419 N LOVINGTON HWY
Mailing Address - Street 2:COMPLEX 5 STE. 15
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-9131
Mailing Address - Country:US
Mailing Address - Phone:505-392-1973
Mailing Address - Fax:
Practice Address - Street 1:5419 N LOVINGTON HWY
Practice Address - Street 2:COMPLEX 5 STE. 15
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-9131
Practice Address - Country:US
Practice Address - Phone:505-392-1973
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMB4739Medicaid
NMB4739Medicaid
NM6028770001Medicare NSC