1245479070 NPI number — CAMEL ROCK ENTERPRISES INC.

Table of content: (NPI 1245479070)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245479070 NPI number — CAMEL ROCK ENTERPRISES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAMEL ROCK ENTERPRISES INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245479070
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 34
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CAUSEY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88113-0034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-273-4204
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1650 LOS LENTES RD NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOS LUNAS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87031-9316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-273-4204
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SKELLEY
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
575-273-4204

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  2116 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)