| County Line Medical Service Inc | |
|
545 S County Line Dr Spc A Chaparral NM 88081-7802 | |
| (575) 824-5007 | |
| Not Available |
| Full Name | County Line Medical Service Inc |
|---|---|
| Speciality | Family Medicine |
| Location | 545 S County Line Dr Spc A, Chaparral, New Mexico |
| Authorized Official Name and Position | Kyong Yol Ko (MD / PRESIDENT) |
| Authorized Official Contact | 5758245007 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| County Line Medical Service Inc 545 S County Line Dr Spc A Chaparral NM 88081-7802 Ph: (575) 824-5007 | County Line Medical Service Inc 545 S County Line Dr Spc A Chaparral NM 88081-7802 Ph: (575) 824-5007 |
| NPI Number | 1538199773 |
|---|---|
| Provider Enumeration Date | 07/04/2006 |
| Last Update Date | 12/10/2013 |
| Medicare PECOS PAC ID | 8820092372 |
|---|---|
| Medicare Enrollment ID | O20060914000286 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538199773 | NPI | - | NPPES |
| DF0606 | Other | RR MEDICARE | |
| 40725391 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Kyong Y Ko |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1720083322 PECOS PAC ID: 0840274064 Enrollment ID: I20040615001780 |
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