Basic Information
| Provider Information | |||||||||
| NPI: | 1285082065 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | NOR-LEA HOSPITAL DISTRICT | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | HOBBS SPECIALTY CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1923 N DAL PASO ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882403023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754333000 | ||||||||
| FaxNumber: | 5753961454 | ||||||||
| Practice Location | |||||||||
| Address1: | 1923 N DAL PASO ST | ||||||||
| Address2: | SUITE B | ||||||||
| City: | HOBBS | ||||||||
| State: | NM | ||||||||
| PostalCode: | 882403023 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754333000 | ||||||||
| FaxNumber: | 5753961454 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/02/2016 | ||||||||
| LastUpdateDate: | 01/27/2017 | ||||||||
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| AuthorizedOfficialLastName: | SHAW | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | B | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5753966611 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | NOR-LEA HOSPITAL DISTRICT | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | 1T3543 | NM | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.