Healthcare Provider Details

I. General information

NPI: 1942393616
Provider Name (Legal Business Name): LIVING CROSS AMBULANCE SERVICE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1355 WEST BOSQUE LOOP
BOSQUE FARMS NM
87068-9271
US

IV. Provider business mailing address

P.O. BOX 888
PERALTA NM
87042-0888
US

V. Phone/Fax

Practice location:
  • Phone: 505-869-0800
  • Fax: 505-869-8242
Mailing address:
  • Phone: 505-869-0800
  • Fax: 505-869-8242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number02-066619-00-5
License Number StateNM

VIII. Authorized Official

Name: MR. DAVID BRIS
Title or Position: PRESIDENT
Credential:
Phone: 505-869-0800