Provider Demographics
NPI:1932123288
Name:FARMINGTON INTERNAL MEDICINE, P.C.
Entity Type:Organization
Organization Name:FARMINGTON INTERNAL MEDICINE, P.C.
Other - Org Name:CUMBERWORTH/BARRY PRATHER MD'S
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELEANORE
Authorized Official - Middle Name:
Authorized Official - Last Name:BARRY-PRATHER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-325-5025
Mailing Address - Street 1:657A W MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-5967
Mailing Address - Country:US
Mailing Address - Phone:505-325-5025
Mailing Address - Fax:505-325-0689
Practice Address - Street 1:657A W MAPLE ST
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-5967
Practice Address - Country:US
Practice Address - Phone:505-325-5025
Practice Address - Fax:505-325-0689
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-27
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM06452-6R#Z6215Medicaid
NM500521016Medicare PIN