Provider Demographics
NPI:1497872931
Name:ALAMOGORDO EAR NOSE & THROAT - FACIAL PLASTIC SURGERY PC
Entity Type:Organization
Organization Name:ALAMOGORDO EAR NOSE & THROAT - FACIAL PLASTIC SURGERY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:W
Authorized Official - Last Name:FROST
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-437-4533
Mailing Address - Street 1:1401 10TH ST STE C
Mailing Address - Street 2:
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5012
Mailing Address - Country:US
Mailing Address - Phone:505-437-4533
Mailing Address - Fax:
Practice Address - Street 1:1401 10TH ST STE C
Practice Address - Street 2:
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5012
Practice Address - Country:US
Practice Address - Phone:505-437-4533
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-22
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM44378Medicaid
NM44378Medicaid