Basic Information
| Provider Information | |||||||||
| NPI: | 1174231484 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ROSWELL INFUSIONS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1201 LESLIE LN | ||||||||
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| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882011076 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5734291313 | ||||||||
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| Practice Location | |||||||||
| Address1: | 313 W COUNTRY CLUB RD STE 9 | ||||||||
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| City: | ROSWELL | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882015804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5753471883 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/07/2022 | ||||||||
| LastUpdateDate: | 11/07/2022 | ||||||||
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| AuthorizedOfficialLastName: | KING | ||||||||
| AuthorizedOfficialFirstName: | PRESTON | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 5734291313 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DNP, CRNA. | ||||||||
| NPICertificationDate: | 11/07/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QI0500X | N | Ambulatory Health Care Facilities | Clinic/Center | Infusion Therapy | 261QP3300X | N | Ambulatory Health Care Facilities | Clinic/Center | Pain | 207LP2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.