Provider Demographics
NPI:1891005534
Name:VALLEY EMERGENCY PHYSICIANS NEW MEXICO PC
Entity Type:Organization
Organization Name:VALLEY EMERGENCY PHYSICIANS NEW MEXICO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:P
Authorized Official - Last Name:MARON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-447-0296
Mailing Address - Street 1:PO BOX 10414
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-0414
Mailing Address - Country:US
Mailing Address - Phone:562-809-3519
Mailing Address - Fax:
Practice Address - Street 1:2100 N MLK BLVD
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101-9412
Practice Address - Country:US
Practice Address - Phone:575-769-2141
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2016-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM36435341Medicaid
NMNMA101701Medicare PIN