| Pangea Medical Llc | |
|
2604 Gaye Dr Roswell NM 88201-3427 | |
| (575) 578-4548 | |
| Not Available |
| Full Name | Pangea Medical Llc |
|---|---|
| Speciality | Clinic/center - Adult Mental Health |
| Location | 2604 Gaye Dr, Roswell, New Mexico |
| Authorized Official Name and Position | Steven Ray Black (M.D.) |
| Authorized Official Contact | 5755784548 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pangea Medical Llc 2604 Gaye Dr Roswell NM 88201-3427 Ph: (575) 578-4548 | Pangea Medical Llc 2604 Gaye Dr Roswell NM 88201-3427 Ph: (575) 578-4548 |
| NPI Number | 1457619934 |
|---|---|
| Provider Enumeration Date | 05/02/2012 |
| Last Update Date | 05/02/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457619934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | MD2011-0547 (New Mexico) | Primary |
| 261QP2300X | Clinic/center - Primary Care | MD2011-0547 (New Mexico) | Secondary |
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