1992832455 NPI number — NATIVE RESOURCE DEVELOPMENT COMPANY INC.

Table of content: (NPI 1992832455)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992832455 NPI number — NATIVE RESOURCE DEVELOPMENT COMPANY INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NATIVE RESOURCE DEVELOPMENT COMPANY 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:
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:
1992832455
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
318 DEE ANN AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLUP
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87301-5783
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-726-0201
Provider Business Mailing Address Fax Number:
505-726-0202

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
318 DEE ANN AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLUP
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87301-5783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-726-0201
Provider Business Practice Location Address Fax Number:
505-726-0202
Provider Enumeration Date:
02/28/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EMERSON
Authorized Official First Name:
PENNY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-867-5372

Provider Taxonomy Codes

  • Taxonomy code: 253Z00000X , with the licence number:  777245 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 30550297 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 343900000X , with the licence number: 073338 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253Z00000X , with the licence number: 24855731 , 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: 43979203 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 24855731 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30550297 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 073338 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 777245 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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