LDR Medical Clinic, LLC

Primary specialty

Primary Care Clinic/CenterTaxonomy code 261QP2300X

License

AP3306 Issued in AZ

Legal business name

LDR MEDICAL CLINIC, LLC

Practice address

305 W Second St
Winslow, AZ 86047-3406

Phone

(928) 289-6093

Fax

(928) 289-6787

NPI assigned

Dec 6, 2017

Organization subpart

No

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

Authorized official

Name

Ms. Lisa Diane Romero, FNP-C

Title

Nurse Practitioner, Business Owner

Phone

(928) 289-6093

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1512518400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1529107200000",
    "number": "1255846788",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "305 W SECOND ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473406",
            "telephone_number": "928-289-6093",
            "fax_number": "928-289-6787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "305 W SECOND ST",
            "city": "WINSLOW",
            "state": "AZ",
            "postal_code": "860473406",
            "telephone_number": "928-289-6093",
            "fax_number": "928-289-6787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LDR MEDICAL CLINIC, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-12-06",
        "last_updated": "2018-06-16",
        "status": "A",
        "authorized_official_last_name": "ROMERO",
        "authorized_official_first_name": "LISA",
        "authorized_official_middle_name": "DIANE",
        "authorized_official_title_or_position": "NURSE PRACTITIONER, BUSINESS OWNER",
        "authorized_official_telephone_number": "928-289-6093",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "FNP-C"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "AZ",
            "license": "AP3306",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1255575411",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Toby Daniel Laird
• Carlos E Lantigua Palin
• Michael Laplante
• Robin Larson, RN
• William Daniel Laster, PHARMD
• Salvador T Lee Jr., M.D.
• Yvonne Lee, DMD
• John Eric Leonard, ATC
• Robert A Lindinger, DDS
• Little Colorado Emergency Physicians LLC

• Primary Care Clinic/Center in Winslow, AZ
• Providers in Winslow, AZ by specialty
• Primary Care Clinic/Center in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 16, 2018; 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.