Northern New Mexico Surgical Services PC

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD2013-0738 Issued in NM

Legal business name

NORTHERN NEW MEXICO SURGICAL SERVICES PC

Practice address

300 Wilson St
Clayton, NM 88415-3304

Phone

(575) 374-0021

NPI assigned

Dec 9, 2014

Last updated

Jan 22, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Jacque Callis

Title

Credentialing Assistant

Phone

(575) 207-8890

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1418083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1421884800000",
    "number": "1740688548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 545",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884150545",
            "telephone_number": "575-374-0021"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "300 WILSON ST",
            "city": "CLAYTON",
            "state": "NM",
            "postal_code": "884153304",
            "telephone_number": "575-374-0021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHERN NEW MEXICO SURGICAL SERVICES PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-12-09",
        "last_updated": "2015-01-22",
        "status": "A",
        "authorized_official_last_name": "CALLIS",
        "authorized_official_first_name": "JACQUE",
        "authorized_official_title_or_position": "CREDENTIALING ASSISTANT",
        "authorized_official_telephone_number": "575-207-8890"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "NM",
            "license": "MD2013-0738",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Topaz Rene McQueen
• Cynthia Medina
• James R Mize III
• Jamie Sue Moehring
• Angela Montoya
• Rosemary Padilla
• Michelle A Paquin, MSN, ARNP, BC, ANP
• Sidney Poling
• Rose Ramirez, CCS
• Lana C Ramos, RPT

• Surgery Physician in Clayton, NM
• Providers in Clayton, NM by specialty
• Surgery Physician in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2015; 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.