Provider Demographics
NPI:1821598830
Name:G & M MEDICAL CENTER LLC
Entity Type:Organization
Organization Name:G & M MEDICAL CENTER LLC
Other - Org Name:G & M MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:EDWARDS
Authorized Official - Suffix:
Authorized Official - Credentials:FNP-BC, AGACNP
Authorized Official - Phone:505-415-0719
Mailing Address - Street 1:1316 JACKIE RD SE STE 500
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6618
Mailing Address - Country:US
Mailing Address - Phone:505-415-0719
Mailing Address - Fax:505-214-5190
Practice Address - Street 1:1316 JACKIE RD SE STE 500
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-6618
Practice Address - Country:US
Practice Address - Phone:505-415-0719
Practice Address - Fax:505-214-5190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-16
Last Update Date:2022-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-03224207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty