Provider Demographics
NPI:1114592417
Name:LOCKMILLER HEALTH & WELLNESS LLC
Entity type:Organization
Organization Name:LOCKMILLER HEALTH & WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AARON
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOCKMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:575-742-8911
Mailing Address - Street 1:608 NORTH PRINCE STREET
Mailing Address - Street 2:SUITE C
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88101
Mailing Address - Country:US
Mailing Address - Phone:575-742-8911
Mailing Address - Fax:
Practice Address - Street 1:608 NORTH PRINCE STREET
Practice Address - Street 2:SUITE C
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-742-8911
Practice Address - Fax:575-742-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-20
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1417571258OtherNPI