Taos Sports Medicine Serices LLC

Primary specialty

Orthopedic Physical TherapistTaxonomy code 2251X0800X

License

3072B1 Issued in NM

Legal business name

TAOS SPORTS MEDICINE SERICES LLC

Doing business as

Angel Fire Physical Therapy

Practice address

12 Crestview Drive
Ste 1S
Angel Fire, NM 87710-0489

Phone

(575) 377-1900

Fax

(575) 377-2383

NPI assigned

Sep 16, 2010

Last updated

Sep 16, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

TAOS SPORTS MEDICINE SERVICES, LLCAs reported in NPPES

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

Authorized official

Name

Jocelyn Lucero

Title

Office Manager

Phone

(575) 737-0304

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Angel Fire Physical Therapy Doing business as

Part of

Taos Sports Medicine Serices LLC

Member of 1

Organizations this organization is a member of, according to the National Provider Directory.

• Taos Health Systems, Inc., Holy Cross Hospital

  • Critical Access Hospital
  • Taos, NM
  • NPI 1902338049

  Member Of

  NPD member

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

• Taos Sports Medicine Services LLC

  dba dba Taos MRI Services

  • Magnetic Resonance Imaging Radiologic Technologist
  • Taos, NM
  • NPI 1407012388
  NPPES parent name

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

{
    "created_epoch": "1284595200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284595200000",
    "number": "1659689347",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1398 WEIMER RD",
            "address_2": "STE 203",
            "city": "TAOS",
            "state": "NM",
            "postal_code": "875716397",
            "telephone_number": "575-737-0304",
            "fax_number": "575-737-0383"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12 CRESTVIEW DRIVE",
            "address_2": "STE 1S",
            "city": "ANGEL FIRE",
            "state": "NM",
            "postal_code": "877100489",
            "telephone_number": "575-377-1900",
            "fax_number": "575-377-2383"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TAOS SPORTS MEDICINE SERICES LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TAOS SPORTS MEDICINE SERVICES, LLC",
        "enumeration_date": "2010-09-16",
        "last_updated": "2010-09-16",
        "status": "A",
        "authorized_official_last_name": "LUCERO",
        "authorized_official_first_name": "JOCELYN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "575-737-0304"
    },
    "taxonomies": [
        {
            "code": "2251X0800X",
            "taxonomy_group": "",
            "desc": "Physical Therapist, Orthopedic",
            "state": "NM",
            "license": "3072B1",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE GROUP PTAN",
            "identifier": "700521047",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "43383386",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Angel Fire Physical Therapy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Janet S Oliver, LPCC
• Presbyterian Healthcare Services (Moreno Valley Healthcare Clinic)
• South Central Colfax County Special Hospital District (Moreno Valley Healthcare Clinic)
• South Central Colfax County Special Hospital District (Moreno Valley Urgent Care @ Angel Fire Resort)
• Sunrise Clinics (Sunrise Clinics Moreno Vally High)
• The Longevity Chiropractic Center
• Ultimed Red River, Inc. (ultiMED Angel Fire)
• Margaret Vanantwerp, CNP
• Village of Angel Fire (Angel Fire EMS)

• Orthopedic Physical Therapist in Angel Fire, NM
• Providers in Angel Fire, NM by specialty
• Orthopedic Physical Therapist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2010; 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.