1215194493 NPI number — TOWN OF VAUGHN

Table of content: (NPI 1215194493)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215194493 NPI number — TOWN OF VAUGHN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF VAUGHN
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:
1215194493
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 278
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VAUGHN
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-584-2301
Provider Business Mailing Address Fax Number:
575-584-2940

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
322 E. 8TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VAUGHN
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-584-2301
Provider Business Practice Location Address Fax Number:
575-584-2940
Provider Enumeration Date:
05/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
LOPEZ
Authorized Official First Name:
SHALINE
Authorized Official Middle Name:
Authorized Official Title or Position:
CLERK/TREASURER
Authorized Official Telephone Number:
575-584-2301

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  0311359 , 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: 000R1637 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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