CLOVIS SURGERY CENTER NM LLC (NPI# 1912512542) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1912512542 |
| Entity Type | Organization |
| Organization Name | CLOVIS SURGERY CENTER NM LLC |
| Practice Address |
1820 W 21st St Clovis NM 88101-4024 |
| Mailing Address |
921 E 21st St Ste C Clovis NM 88101-4443 |
| Practice Telephone | 5759353668 |
| Practice Fax Number | 5759353669 |
| Mailing Telephone | 5759353668 |
| Enumeration Date | 2020-09-10 |
| Last Update Date | 2020-09-10 |
| Authorized Official Name | DEVIN WAHLEN (OWNER) |
| Authorized Official Telephone | 5759353668 |
| Authorized Official Credential | DPM |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207XX0004X |
Orthopaedic Surgery Specialization: Foot and Ankle Surgery |
Allopathic & Osteopathic Physicians |
| Street Address |
1820 W 21ST ST |
| City | CLOVIS |
| State | NM |
| Zip Code | 88101-4024 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861473803 | Albert M Kwan | Family Medicine | 1820 W 21st St, Clovis, NM 88101-4024 | 2005-11-08 |
| 1437695327 | Eastern New Mexico Foot & Ankle, PC | Podiatrist | 1820 W 21st St, Clovis, NM 88101-4024 | 2017-01-16 |
| 1316259930 | Devin Dean Wahlen | Podiatrist | 1820 W 21st St, Clovis, NM 88101-4024 | 2010-07-12 |
| 1477734747 | Albert M Kwan Md PC | Surgery | 1820 W 21st St, Clovis, NM 88101-4024 | 2007-11-15 |
| 1649251679 | Clovis Surgery Center LLC | Clinic/Center | 1820 W 21st St, Clovis, NM 88101-4024 | 2005-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1134748692 | Patrick James Scollon | Military Health Care Provider | 104 W D. L. Ingram Ave, Cannon Afb, Nm 88101, Cannon Afb, NM 88101 | 2020-04-14 |
| 1285274878 | Keishla Cota | Physical Therapist | 100 East Manana Blvd, Unit 1, Clovis, NM 88101 | 2020-01-10 |
| 1659927283 | Ndeye Ndour | Nurse Anesthetist, Certified Registered | 2100 N M.l.k. Jr Blvd, Clovis, NM 88101 | 2019-08-09 |
| 1679132468 | Justine Nicole Nunez | Nurse Practitioner | 2301 North Doctor Martin Luther King Boulevard, Clovis, NM 88101 | 2019-06-06 |
| 1518453521 | Moore Psychological Services, Pllc | Social Worker | 1908 West 21st Street, Clovis, NM 88101 | 2018-07-03 |
| 1912494006 | Raesha Russell | Behavior Technician | 214 West 9th St, Clovis, NM 88101 | 2018-04-16 |
| 1013425800 | Vanessa Yardley | Registered Nurse | 2100 N. Martin Luther King Jr. Blvd., Clovis, NM 88101 | 2018-01-16 |
| 1699204230 | Olivia Garcia | Technician, Other | 1100 W 21st Street, Clovis, NM 88101 | 2017-06-07 |
| 1578006250 | Mary Ellen Gray | Technician, Other | 9408 B Vermont Court, Clovis, NM 88101 | 2016-11-29 |
| 1205296977 | Malaney Harmon | Behavioral Analyst | 2700 E 7th St., Clovis, NM 88101 | 2016-02-24 |
| Find all providers in zip 88101 | ||||
| Taxonomy Code | 207XX0004X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Orthopaedic Surgery |
| Specialization | Foot and Ankle Surgery |
| Recognized by several state medical boards as a fellowship subspecialty program of orthopaedic surgery, foot and ankle surgeons deal with adult reconstructive foot and ankle surgery, adult foot and ankle trauma, sports medicine foot and ankle, and children's foot and ankle reconstructive surgery. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: title modified, definiton added, source added] Additional Resources: American Board of Orthopaedic Surgery, 2007. http://www.abos.org/. Separate board certification is not currently offered. ACGME Accredited Residency Program Requirements: 1 year of training with 5 years Orthopedic Surgery for a total of 6 years. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1538403894 | St. Vincent Hospital | Orthopaedic Surgery | 2968 Rodeo Park Dr W Ste 150, Santa Fe, NM 87505-6351 | 2012-11-26 |
| 1740546563 | Katherine J Gavin | Orthopaedic Surgery | Msc 10 5600 1 University of New Mexico, Albuquerque, NM 87131 | 2012-04-05 |
| 1235223611 | Richmond Kilpatrick | Orthopaedic Surgery | 201 Cedar St Se Ste 46304th, Pmg Cedar Podiatry, Albuquerque, NM 87106-4917 | 2006-10-03 |
| 1467907782 | Kalyani Orthopaedics LLC | Orthopaedic Surgery | 4371 E Lohman Ave, Las Cruces, NM 88011-8255 | 2016-08-16 |
| 1326055385 | Richard Miller | Orthopaedic Surgery | 2nd Ambulatory Care Ctr, 2211 Lomas Blvd. Ne, Albuquerque, NM 87131-0001 | 2006-08-02 |
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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.