NPIMap

Organization Active NPI

Eastern New Mexico Physicians and Surgeons LLC

  • Clinic/Center
  • Clovis, NM
National Provider Identifier
1114977675
Registry record updated May 12, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
EASTERN NEW MEXICO PHYSICIANS AND SURGEONS LLC
Practice address
2425 W 21St Street
Clovis, NM 88101
Phone
(505) 763-9800
Fax
(505) 769-1998
NPI assigned
May 12, 2006
Last updated
May 12, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on May 12, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Lonnie J Ray
Title
Practice Administrator
Phone
(505) 763-9800

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X Primary

Addresses

Primary practice location

2425 W 21St Street
Clovis, NM 88101

Mailing address

2425 W 21St Street
Clovis, NM 88101
Phone (505) 763-9800

Other identifiers 4

IdentifierTypeStateIssuer
78904374MedicaidNM
00NM001B06OtherNMBCBS OF NM
03-07242-6000OtherNMCRS-1 NUMBER
DF1773OtherNMRAILROAD MEDICARE PIN

National Provider Directory

National Provider Directory

Locations

2425 W 21st St
Clovis, NM 88101
Phone (505) 763-1197

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1147392000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1210550400000",
    "number": "1114977675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2425 W 21ST STREET",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "88101",
            "telephone_number": "505-763-9800",
            "fax_number": "505-769-1998"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2425 W 21ST STREET",
            "city": "CLOVIS",
            "state": "NM",
            "postal_code": "88101",
            "telephone_number": "505-763-9800",
            "fax_number": "505-769-1998"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "EASTERN NEW MEXICO PHYSICIANS AND SURGEONS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-05-12",
        "last_updated": "2008-05-12",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "LONNIE",
        "authorized_official_middle_name": "J",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "505-763-9800"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "78904374",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF NM",
            "identifier": "00NM001B06",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "CRS-1 NUMBER",
            "identifier": "03-07242-6000",
            "state": "NM"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE PIN",
            "identifier": "DF1773",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Clovis, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.