| Rapha Provider Agency LLC | |
|
1215 Gusdorf Rd Ste A Taos NM 87571-6914 | |
| (575) 770-7139 | |
| Not Available |
| Full Name | Rapha Provider Agency LLC |
|---|---|
| Speciality | Social Worker |
| Location | 1215 Gusdorf Rd Ste A, Taos, New Mexico |
| Authorized Official Name and Position | Christopher H Weathers (OWNER/BSC) |
| Authorized Official Contact | 5757707139 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rapha Provider Agency LLC 1215 Gusdorf Rd Ste A Taos NM 87571-6914 Ph: (575) 770-7139 | Rapha Provider Agency LLC 1215 Gusdorf Rd Ste A Taos NM 87571-6914 Ph: (575) 770-7139 |
| NPI Number | 1588200984 |
|---|---|
| Provider Enumeration Date | 11/20/2019 |
| Last Update Date | 09/18/2023 |
| Certification Date | 09/18/2023 |
| Medicare PECOS PAC ID | 3072990308 |
|---|---|
| Medicare Enrollment ID | O20220506000934 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588200984 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | () | Primary |
| 251S00000X | Community/behavioral Health | () | Secondary |
| Provider Name | Christopher H Weathers |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295281566 PECOS PAC ID: 8022440809 Enrollment ID: I20191115002150 |
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