Provider Demographics
NPI:1366579492
Name:HIGH DESERT FAMILY MEDICINE LLC
Entity type:Organization
Organization Name:HIGH DESERT FAMILY MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JANE
Authorized Official - Middle Name:A
Authorized Official - Last Name:RUGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-325-9555
Mailing Address - Street 1:4801 N BUTLER AVE STE 3102
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:NM
Mailing Address - Zip Code:87401-0815
Mailing Address - Country:US
Mailing Address - Phone:505-325-9555
Mailing Address - Fax:505-325-9306
Practice Address - Street 1:4801 N BUTLER AVE STE 3102
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:NM
Practice Address - Zip Code:87401-0815
Practice Address - Country:US
Practice Address - Phone:505-325-9555
Practice Address - Fax:505-325-9306
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherTAX ID