Provider Demographics
NPI:1811925662
Name:SCOR PC
Entity type:Organization
Organization Name:SCOR PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROEHLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-622-7600
Mailing Address - Street 1:115 E 19TH ST
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-5151
Mailing Address - Country:US
Mailing Address - Phone:575-622-7600
Mailing Address - Fax:575-622-3856
Practice Address - Street 1:115 E 19TH ST
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-5151
Practice Address - Country:US
Practice Address - Phone:575-622-7600
Practice Address - Fax:575-622-3856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-29
Last Update Date:2015-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM0447240001Medicare NSC