| Zia Primary Care, Llc | |
|
104 Quail Trl Ste B Edgewood NM 87015-7197 | |
| (505) 926-9800 | |
| Not Available |
| Full Name | Zia Primary Care, Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 104 Quail Trl Ste B, Edgewood, New Mexico |
| Authorized Official Name and Position | Ashley Autrey (CREDENTIALING) |
| Authorized Official Contact | 5052491369 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Zia Primary Care, Llc 104 Quail Trl Ste B Edgewood NM 87015-7197 Ph: (505) 926-9800 | Zia Primary Care, Llc 104 Quail Trl Ste B Edgewood NM 87015-7197 Ph: (505) 926-9800 |
| NPI Number | 1831802230 |
|---|---|
| Provider Enumeration Date | 12/30/2022 |
| Last Update Date | 01/28/2023 |
| Medicare PECOS PAC ID | 6103290606 |
|---|---|
| Medicare Enrollment ID | O20230324000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831802230 | NPI | - | NPPES |
| Provider Name | Jodi A Dettman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720269178 PECOS PAC ID: 4082791702 Enrollment ID: I20080404000716 |
| Provider Name | Lindsay Sue Cerrone |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1861028102 PECOS PAC ID: 7719393495 Enrollment ID: I20210303002312 |
New Mexico Medical Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1851 Old Us 66, Unit 1, Edgewood, NM 87015 Phone: 505-286-2396 Fax: 505-286-2398 | |
Cerrone Family Healthcare, Llc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 104 Quail Trl Ste B, Edgewood, NM 87015 Phone: 505-926-9800 | |
First Choice Community Healthcare, Inc Primary Care Clinic Medicare: Medicare Enrolled Practice Location: 7 Municipal Way, Edgewood, NM 87015 Phone: 505-281-3406 Fax: 505-224-8737 |