Healthcare Provider Details

I. General information

NPI: 1063171098
Provider Name (Legal Business Name): BERNALILLO COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2021
Last Update Date: 02/09/2022
Certification Date: 02/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6840 2ND ST NW STE 207
ALBUQUERQUE NM
87107-6050
US

IV. Provider business mailing address

6840 2ND ST NW
ALBUQUERQUE NM
87107-6050
US

V. Phone/Fax

Practice location:
  • Phone: 505-468-1302
  • Fax: 505-462-9749
Mailing address:
  • Phone: 505-468-1302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: ROBERT GALLEGOS
Title or Position: EMS DIVISION CHIEF
Credential:
Phone: 505-468-1302