Healthcare Provider Details

I. General information

NPI: 1245698513
Provider Name (Legal Business Name): ROCKY MTN EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 02/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5100 SAN FRANCISCO RD NE SUITE A
ALBUQUERQUE NM
87109-4630
US

IV. Provider business mailing address

5100 SAN FRANCISCO RD NE SUITE A
ALBUQUERQUE NM
87109-4630
US

V. Phone/Fax

Practice location:
  • Phone: 505-328-6269
  • Fax:
Mailing address:
  • Phone: 505-328-6269
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number5133742
License Number StateNM

VIII. Authorized Official

Name: EDWARD S. LITTLE
Title or Position: CEO
Credential:
Phone: 505-328-6269