Healthcare Provider Details

I. General information

NPI: 1750484010
Provider Name (Legal Business Name): VILLAGE OF COLUMBUS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 08/30/2023
Certification Date: 08/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 SOUTH WISCONSIN ST.
COLUMBUS NM
88029-0308
US

IV. Provider business mailing address

10802 FARNAM DR
OMAHA NE
68154-3237
US

V. Phone/Fax

Practice location:
  • Phone: 505-531-2225
  • Fax: 505-531-2221
Mailing address:
  • Phone: 531-895-5853
  • Fax: 877-343-0131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number17527
License Number StateNM

VIII. Authorized Official

Name: MS. MARIA RAMIREZ
Title or Position: FIRE / EMS CLERK
Credential:
Phone: 575-543-9216