Provider Demographics
NPI:1174716781
Name:MICHAEL A ROWLEY MD PA
Entity type:Organization
Organization Name:MICHAEL A ROWLEY MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DIRONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:WALLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-762-5955
Mailing Address - Street 1:PO BOX 928
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:NM
Mailing Address - Zip Code:88102-0928
Mailing Address - Country:US
Mailing Address - Phone:575-762-5955
Mailing Address - Fax:575-762-3909
Practice Address - Street 1:2100 N MLK JR BLVD
Practice Address - Street 2:RADIOLOGY DEPARTMENT
Practice Address - City:CLOVIS
Practice Address - State:NM
Practice Address - Zip Code:88101
Practice Address - Country:US
Practice Address - Phone:575-769-7350
Practice Address - Fax:575-769-7296
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-27
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM80-2932085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02899Medicaid
NMNM007F30OtherBLUE CROSS
NM02899Medicaid
NMD35927Medicare UPIN