1487188785 NPI number — BOARD OF COMMISSIONERS CITY OF LAS CRUCES

Table of content: (NPI 1487188785)

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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