| Enmu Sports Medicine | |
|
1500 S Avenue K Portales NM 88130-7400 | |
| (972) 367-4845 | |
| (972) 367-3451 |
| Full Name | Enmu Sports Medicine |
|---|---|
| Speciality | Family Medicine |
| Location | 1500 S Avenue K, Portales, New Mexico |
| Authorized Official Name and Position | Mouzon Bass (AGENT) |
| Authorized Official Contact | 9723674845 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Enmu Sports Medicine Po Box 650850 Dallas TX 75265-0850 Ph: (800) 555-9073 | Enmu Sports Medicine 1500 S Avenue K Portales NM 88130-7400 Ph: (972) 367-4845 |
| NPI Number | 1053794727 |
|---|---|
| Provider Enumeration Date | 06/30/2015 |
| Last Update Date | 06/30/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053794727 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 207QS0010X | Family Medicine - Sports Medicine | (* (Not Available)) | Secondary |
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