Provider Demographics
NPI:1215300926
Name:HEART PATH ORIENTAL MEDICINE
Entity type:Organization
Organization Name:HEART PATH ORIENTAL MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:KEELY
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:HOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:575-917-2684
Mailing Address - Street 1:510 W. TEXAS
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88210
Mailing Address - Country:US
Mailing Address - Phone:575-622-7109
Mailing Address - Fax:575-627-8439
Practice Address - Street 1:810 N UNION
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-622-7109
Practice Address - Fax:575-627-8439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-03
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1046261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center