Provider Demographics
NPI:1053546796
Name:SIAVASH KARIMIAN MD OF NEW MEXICO PC DBA ROSWELL MEDICO
Entity type:Organization
Organization Name:SIAVASH KARIMIAN MD OF NEW MEXICO PC DBA ROSWELL MEDICO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWENR
Authorized Official - Prefix:MR
Authorized Official - First Name:SIAVASH
Authorized Official - Middle Name:
Authorized Official - Last Name:KARIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:575-625-8430
Mailing Address - Street 1:PO BOX 1617
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88202-1617
Mailing Address - Country:US
Mailing Address - Phone:575-625-8430
Mailing Address - Fax:575-625-8452
Practice Address - Street 1:1621 N. WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201
Practice Address - Country:US
Practice Address - Phone:575-625-8430
Practice Address - Fax:575-625-8452
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIAVASH KARIMIAN MD OF NEW MEXICO PC DBA ROSWELL MEDICO
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-05-26
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM143171101YP2500X
NMMD2011-0412174400000X
NMMD2007-0234207Q00000X
NM2001-PA31363A00000X
NMCNP02096363LA2100X
NMCNP001177363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty