Provider Demographics
NPI:1811219041
Name:EMERY FAMILY & WELLNESS MEDICINE INC
Entity Type:Organization
Organization Name:EMERY FAMILY & WELLNESS MEDICINE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:EMERY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:505-918-0029
Mailing Address - Street 1:2009 CLEARWATER LOOP NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87144-5553
Mailing Address - Country:US
Mailing Address - Phone:505-918-0029
Mailing Address - Fax:
Practice Address - Street 1:1400 BARBARA LOOP SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-1088
Practice Address - Country:US
Practice Address - Phone:505-918-0029
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-15
Last Update Date:2010-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA112699207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000Z9435Medicaid
G69920Medicare UPIN
342419801Medicare PIN