| Indian Wells Family Practice | |
|
2474 Indian Wells Rd Alamogordo NM 88310-3831 | |
| (575) 443-0339 | |
| (575) 434-5624 |
| Full Name | Indian Wells Family Practice |
|---|---|
| Speciality | Clinic/Center |
| Location | 2474 Indian Wells Rd, Alamogordo, New Mexico |
| Authorized Official Name and Position | Dan H Moezzi (PRESIDENT) |
| Authorized Official Contact | 5754430339 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Indian Wells Family Practice 2474 Indian Wells Rd Alamogordo NM 88310-3831 Ph: (575) 443-0339 | Indian Wells Family Practice 2474 Indian Wells Rd Alamogordo NM 88310-3831 Ph: (575) 443-0339 |
| NPI Number | 1962415364 |
|---|---|
| Provider Enumeration Date | 08/15/2006 |
| Last Update Date | 02/21/2010 |
| Medicare PECOS PAC ID | 6103920194 |
|---|---|
| Medicare Enrollment ID | O20070330000596 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1962415364 | NPI | - | NPPES |
| H1455 | Medicaid | NM | |
| 201017118 | Other | NM | PRESBYTERIAN HEALTH CARE |
| NM004493 | Other | NM | BLUE CROSS BLUE SHIELD |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | 95-302 (New Mexico) | Primary |
| Provider Name | Dan H Moezzi |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1275699357 PECOS PAC ID: 2567566557 Enrollment ID: I20090106000248 |
| Provider Name | Effat Kay Banikarim |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1538225610 PECOS PAC ID: 9830293828 Enrollment ID: I20100920001101 |
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