MARK EDWARD VAN WORMER (NPI# 1013919034) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013919034 |
| Entity Type | Individual |
| Full Name | MARK EDWARD VAN WORMER |
| Credential | MD |
| Practice Address |
314 N 3rd Ave Clayton NM 88415-3302 |
| Practice Telephone | 5753748313 |
| Practice Fax Number | 5753742064 |
| Mailing Telephone | 5753748313 |
| Mailing Fax Number | 5753742064 |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2009-07-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208D00000X | General Practice | 81333 | NM | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| NM | 05645 | 05 | |
| RAILROAD MEDICARE | 060000475 | 01 |
| Street Address |
314 N 3RD AVE |
| City | CLAYTON |
| State | NM |
| Zip Code | 88415-3302 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1265897151 | Clayton Health Systems, Inc | Clinic/Center | 314 N 3rd Ave, Clayton, NM 88415-3302 | 2015-12-21 |
| 1285715243 | Clayton Health Systems Inc | Family Medicine | 314 N 3rd Ave, Clayton, NM 88415-3302 | 2006-10-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578954384 | Jeremy Sanchez | Counselor | 17 B South Second St, Clayton, NM 88415 | 2015-02-16 |
| 1841697901 | Morgan Scott | Counselor | 17 B S. Second St, Clayton, NM 88415 | 2014-12-04 |
| 1891028858 | Mary Blan | Counselor | 15 Oak Street, Clayton, NM 88415 | 2009-09-09 |
| 1487887774 | Krista R. Trujillo | Counselor | 17 B S Second St, Clayton, NM 88415 | 2009-09-02 |
| 1295918324 | Southwest Family Medical Care, Inc. | Clinic/Center | 200 Court St., Clayton, NM 88415 | 2007-12-12 |
| 1447344585 | Town of Clayton | Ambulance | 1 Chestnut Street, Clayton, NM 88415 | 2006-10-03 |
| 1699871426 | Michelle A Paquin | Nurse Practitioner | 185 Dr. Michael Jenkins Road, Cms Medical Unit, Clayton, NM 88415 | 2006-09-16 |
| 1033213681 | Sharon L Gonzales | Specialist | 110 Walnut Street Office B, Clayton, NM 88415 | 2006-09-12 |
| 1114979275 | Gary D Longanecker | Counselor | 110 Walnut Street, Office B, Clayton, NM 88415 | 2006-05-17 |
| 1821048695 | Nilo Isidro Rivera | Internal Medicine | 314 North 3rd Av, Clayton, NM 88415 | 2006-05-11 |
| Find all providers in zip 88415 | ||||
| Taxonomy Code | 208D00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | General Practice |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1740310614 | Rabun Medical Center, LLC | General Practice | 773 N Main St, Clayton, GA 30525-4257 | 2007-03-07 |
| 1053413690 | Ambrous O Findley Jr. | General Practice | 331 Ridgecrest Cir, Clayton, GA 30525-4186 | 2006-09-03 |
| 1285677492 | Carl Louis Schopfer | General Practice | 115 S Delsea Dr, Clayton, NJ 08312-1913 | 2006-06-14 |
| 1356602205 | Inmed Clinical Services LLC | General Practice | 773 N Main St, Clayton, GA 30525-4257 | 2012-06-06 |
| 1366687774 | Robin Lee Line | General Practice | 773 N Main St, Clayton, GA 30525-4257 | 2008-12-15 |
| 1629141296 | Cameron Luther Perkins | General Practice | 11491 Us Highway 70 W, Clayton, NC 27520-2207 | 2006-11-15 |
| 1104912096 | Clayton Urgent Care and Family Clinic Pa | General Practice | 11491 Us Highway 70 W, Clayton, NC 27520 | 2006-10-05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023616679 | Gemma Cristina Zapater | General Practice | 923 Calle Fuerte Ne, Albuquerque, NM 87113-2373 | 2020-10-15 |
| 1710596036 | Provider Cares Network LLC | General Practice | 10401 Montgomery Pkwy Ne Ste 1a, Albuquerque, NM 87111-3876 | 2020-07-23 |
| 1154948081 | Designed Health Options, LLC | General Practice | 5065 Corrales Rd., Corrales, NM 87048 | 2020-06-26 |
| 1538714381 | Uyama A Fernandez | General Practice | 400 Gold Ave Sw Ste 220, Albuquerque, NM 87102-3278 | 2019-08-08 |
| 1386180909 | Lisselle Marie Villarrubia Ocasio | General Practice | Msc10 6000 1 University of New Mexico, Albuquerque, NM 87131-5505 | 2017-01-07 |
| 1225586969 | Joan Goldsworthy | General Practice | Unm School of Medicine Msc09 5040, 1 University of New Mexico, Albuquerque, NM 87131-0001 | 2016-09-12 |
| 1033568902 | Karen Griest | General Practice | 68 Pinon Trl, Cedar Crest, NM 87008-9444 | 2016-06-10 |
| 1447610886 | Sean T Mcgee | General Practice | Univeristy of New Mexico, Albuquerque, NM 87131-0001 | 2016-02-27 |
| 1275901266 | Lynn Schrader Sweeney | General Practice | 701 Kerney Dr, Farmington, NM 87401-3660 | 2015-09-08 |
| 1942608708 | Marathon Health, Inc. | General Practice | 2208 W Main St, C/o Concho Employee Health Center, Artesia, NM 88210-3720 | 2014-12-10 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.