Provider Demographics
NPI:1568627586
Name:RUIDOSO GASTROENTEROLOGY, P.C.
Entity Type:Organization
Organization Name:RUIDOSO GASTROENTEROLOGY, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:WORTHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-257-7600
Mailing Address - Street 1:PO BOX 157
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO
Mailing Address - State:NM
Mailing Address - Zip Code:88355-0157
Mailing Address - Country:US
Mailing Address - Phone:575-257-7600
Mailing Address - Fax:575-257-3497
Practice Address - Street 1:1701 SUDDERTH DR
Practice Address - Street 2:
Practice Address - City:RUIDOSO
Practice Address - State:NM
Practice Address - Zip Code:88345-6114
Practice Address - Country:US
Practice Address - Phone:575-257-7600
Practice Address - Fax:575-257-3497
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-21
Last Update Date:2008-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM95-380261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty