RUBEN A. SUPAN LLC NPI 1053802892

NPI Information

NPI: 1053802892
Provider Name: RUBEN A. SUPAN, LLC
Classification: Nurse Practitioner - 363LF0000X
Entity Type: Organization

Specialization: Family

Address:
405 W COUNTRY CLUB RD
ROSWELL, NM
ZIP 88201
Phone: (575) 363-3134
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RUBEN A. SUPAN, LLC is a family nurse practitioner in Roswell, NM. RUBEN A. SUPAN, LLC NPI is 1053802892. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

405 W COUNTRY CLUB RD
ROSWELL, NM
ZIP 88201-209
Phone: (575) 363-3134
Fax: (575) 208-0780

The provider's authorized official is Ruben Supan .
The authorized official title is Nurse Practitioner and has the following contact phone number (505) 409-0831.

The enumeration date for this NPI number is 5/29/2018 and was last updated on 7/6/2021.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LF0000X	Nurse Practitioner	Family			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	23386363	MEDICAID	NEW MEXICO

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/14/2023

NPI Synchronization or Removal

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