Provider Demographics
NPI:1639121759
Name:SURGERY CENTER OF EASTERN NEW MEXICO LLC
Entity Type:Organization
Organization Name:SURGERY CENTER OF EASTERN NEW MEXICO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:MS
Authorized Official - First Name:CASEY
Authorized Official - Middle Name:
Authorized Official - Last Name:MCFARLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-763-2609
Mailing Address - Street 1:2421 W 21ST ST
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101-2006
Mailing Address - Country:US
Mailing Address - Phone:505-763-8800
Mailing Address - Fax:505-763-2630
Practice Address - Street 1:2421 W 21ST ST
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-2006
Practice Address - Country:US
Practice Address - Phone:505-763-8800
Practice Address - Fax:505-763-2630
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-17
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP00382865OtherRAILROAD MEDICARE
NM3239OtherSTATE NUMBER
NM88524728Medicaid
NMNM00SS94OtherBCBSNM