Fedko Emergency Physicians New Mexico LLC
Organization Active NPI Emergency Medicine Physician · Grants, NM
NPI 1770047441 · NPPES record last updated Jan 28, 2019
Key facts
- NPI
- 1770047441
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Emergency Medicine Physician 207P00000X
- Legal business name
- FEDKO EMERGENCY PHYSICIANS NEW MEXICO LLC
- Practice address
- 1016 E Roosevelt Ave
Grants, NM 87020-2118 - Phone
- (505) 287-4446
- NPI assigned
- Jan 28, 2019
- Organization subpart
- No
Authorized official
- Name
- Martin Fedko
- Title
- Owner
- Phone
- (857) 571-2467
Practitioners 132
-
Kristin Benavidez, FNP, MSN, RN
-
Ronald Chad Carver, M.D.
-
Jeffrey D. Durgin, M.D.
-
Joseph Michael Feagan, D.O.
-
Ashley Nycole Ferron, FNP-C
-
Niraj Ganjawala, M.D.
-
Geoffrey Garst, M.D., M.P.H.
-
Lemuel Richard Jones, FNP-BC
-
John D McKie, D.O.
-
Randy C Michael, DO
-
Casey F Onik, DO
-
Homero Renteria, MD
-
Brittnee Rene Sharp, APRN-CNP
-
Barbara Turpin, FNP
-
Carolyn Vavrecan, FNP
-
Terence James Alost, M.D.
-
Spencer Reid Anderson, M.D.
-
Jimmie Ray Appel Jr., M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NM
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20190320001146 | NM | Part B Supplier - Clinic/Group Practice | 4880934389 |
Receives reassigned benefits from 132 practitioners Practice locations: Clovis, NM; Deming, NM; Grants, NM; Portales, NM |
National Provider Directory
Locations
7725 W Reno Ave
Oklahoma City, OK 73127
Phone (405) 206-1313
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Emergency Medicine Physician |
207P00000X | Yes |
Addresses
Primary practice location
1016 E Roosevelt Ave
Grants, NM 87020-2118
Mailing address
7725 W Reno Ave
Oklahoma City, OK 73127-9711
Other providers in Grants, NM
- Josephine Lynnette Elkins
- Emergent Healthcare LLC
- Entrust Home Health Care LLC
- Eugene L Gutierrez
- Family Connections
- Fenton Family Medical LLC
- Daniel Edward Fenton II
- Tiffany Shell Flippen
- Forever United Home Care Group LLC
- Freelance Anesthesia New Mexico, LLC
All providers in Grants, NM · Emergency Medicine Physician in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.