Basic Information
| Provider Information | |||||||||
| NPI: | 1952736183 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OTERO COUNTY MEDICAL GROUP | ||||||||
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| OtherOrganizationName: | ALAMOGORDO CARDIOLOGY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2689 SCENIC DR | ||||||||
| Address2: | |||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883108700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754341699 | ||||||||
| FaxNumber: | 5754348871 | ||||||||
| Practice Location | |||||||||
| Address1: | 2559 MEDICAL DR | ||||||||
| Address2: | SUITE F | ||||||||
| City: | ALAMOGORDO | ||||||||
| State: | NM | ||||||||
| PostalCode: | 883108703 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5754343225 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/06/2013 | ||||||||
| LastUpdateDate: | 09/06/2013 | ||||||||
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| AuthorizedOfficialLastName: | HECKERT | ||||||||
| AuthorizedOfficialFirstName: | ROBERT | ||||||||
| AuthorizedOfficialMiddleName: | JAMES | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5754437845 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | OTERO COUNTY MEDICAL GROUP | ||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | FACHE | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease |
No ID Information.