Healthcare Provider Details

I. General information

NPI: 1225170301
Provider Name (Legal Business Name): MER EDDY COUNTY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 W AZTEC BLVD SUITE 3
AZTEC NM
87410-1868
US

IV. Provider business mailing address

1004 W PIERCE ST
CARLSBAD NM
88220-4057
US

V. Phone/Fax

Practice location:
  • Phone: 505-334-4016
  • Fax: 505-334-1874
Mailing address:
  • Phone: 505-885-4805
  • Fax: 505-885-8833

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MRS. GENNETH ARLENE EASLEY
Title or Position: PRESIDENT & MANAGING EMPLOYEE
Credential:
Phone: 505-885-4805