Ultimed Red River, Inc.

Primary specialty

Urgent Care Clinic/CenterTaxonomy code 261QU0200X

Legal business name

ULTIMED RED RIVER, INC.

Practice address

200A Pioneer Rd
Red River, NM 87558

Phone

(575) 754-1773

NPI assigned

Sep 1, 2010

Last updated

Dec 14, 2010By the provider in NPPES

Organization subpart

Yes

Parent organization

TAOS COMPREHENSIVE HEALTH CORPORATIONAs reported in NPPES

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

Authorized official

Name

Dr. Lesa D Fraker, MDNPI 1164489613

Title

President

Phone

(505) 989-8707

Specialties & licenses 1

Addresses

Tax ID family

Ultimed Angel Fire2 organizations share this tax ID, including this one

Part of

Taos Comprehensive Health

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ultimed Red River, Inc.

  dba ultiMED Angel Fire

  • Urgent Care Clinic/Center
  • Angel Fire, NM
  • NPI 1114220316
  NPD tax ID

Locations

Practitioners 1

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.

• Lesa Deanne Fraker, MD PHD

  • Emergency Medicine Physician
  • Santa Fe, NM
  • NPI 1164489613
  Authorized official Same address or phone

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

{
    "created_epoch": "1283299200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1292284800000",
    "number": "1962719765",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 PASEO DE PERALTA",
            "city": "SANTA FE",
            "state": "NM",
            "postal_code": "875011922",
            "telephone_number": "575-754-1773"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "200A PIONEER RD",
            "city": "RED RIVER",
            "state": "NM",
            "postal_code": "87558",
            "telephone_number": "575-754-1773"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ULTIMED RED RIVER, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "TAOS COMPREHENSIVE HEALTH CORPORATION",
        "enumeration_date": "2010-09-01",
        "last_updated": "2010-12-14",
        "status": "A",
        "authorized_official_last_name": "FRAKER",
        "authorized_official_first_name": "LESA",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "505-989-8707",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QU0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Urgent Care",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alexandra Standish Judycki, COTA/L
• Main Street Medical Center, LLC
• Red River Family Dentistry LLC
• Joy N Stromberg, LMT
• Town of Red River

• Urgent Care Clinic/Center in Red River, NM
• Providers in Red River, NM by specialty
• Urgent Care Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 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.