Provider Demographics
NPI:1346071586
Name:NEW MEXICO PREMIER HEALTH
Entity type:Organization
Organization Name:NEW MEXICO PREMIER HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CNP CFO/CMO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:CHRISTINE
Authorized Official - Last Name:RENFRO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-897-5310
Mailing Address - Street 1:235 MAIN ST SE
Mailing Address - Street 2:
Mailing Address - City:LOS LUNAS
Mailing Address - State:NM
Mailing Address - Zip Code:87031-7316
Mailing Address - Country:US
Mailing Address - Phone:505-388-2223
Mailing Address - Fax:505-404-0113
Practice Address - Street 1:235 MAIN ST SE
Practice Address - Street 2:
Practice Address - City:LOS LUNAS
Practice Address - State:NM
Practice Address - Zip Code:87031-7316
Practice Address - Country:US
Practice Address - Phone:505-388-2223
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-09
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontologyGroup - Multi-Specialty