Provider Demographics
NPI:1700116878
Name:RIO GRANDE MEDICAL, LTD
Entity Type:Organization
Organization Name:RIO GRANDE MEDICAL, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EUGENE
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-532-8900
Mailing Address - Street 1:4351 E LOHMAN AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8259
Mailing Address - Country:US
Mailing Address - Phone:575-532-8900
Mailing Address - Fax:575-532-8963
Practice Address - Street 1:4351 E LOHMAN AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8259
Practice Address - Country:US
Practice Address - Phone:575-532-8900
Practice Address - Fax:575-532-8963
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:RIO GRANDE MEDICAL GROUP, LTD
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-01-12
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty