1053535450 NPI number — CITY OF MOUNTAINAIR

Table of content: (NPI 1053535450)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053535450 NPI number — CITY OF MOUNTAINAIR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF MOUNTAINAIR
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:
6
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:
1053535450
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4501 OSUNA RD NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALBUQUERQUE
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87109-4467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-226-1800
Provider Business Mailing Address Fax Number:
505-247-2482

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 ACOMA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOUNTAINAIR
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87036-0591
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-847-2321
Provider Business Practice Location Address Fax Number:
505-847-0421
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLACKSHEAR
Authorized Official First Name:
SAM
Authorized Official Middle Name:
E
Authorized Official Title or Position:
AMBULANCE CHIEF
Authorized Official Telephone Number:
505-847-2316

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  14303 , 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)

  • Identifier: R2809 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com