1487188785 NPI number — BOARD OF COMMISSIONERS CITY OF LAS CRUCES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487188785 NPI number — BOARD OF COMMISSIONERS CITY OF LAS CRUCES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOARD OF COMMISSIONERS CITY OF LAS CRUCES
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:
1487188785
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/16/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
N2930 STATE ROAD 22
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAUTOMA
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54982-5267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-777-4911
Provider Business Mailing Address Fax Number:
855-642-7228

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 E PICACHO
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-3456
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-528-3473
Provider Business Practice Location Address Fax Number:
575-528-4082
Provider Enumeration Date:
04/13/2017

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
JASON
Authorized Official Middle Name:
LLOYD
Authorized Official Title or Position:
FIRE CHIEF
Authorized Official Telephone Number:
575-528-4074

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , 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)





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