Healthcare Provider Details

I. General information

NPI: 1508182007
Provider Name (Legal Business Name): VILLAGE OF DES MOINES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2010
Last Update Date: 04/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

77 NORTH OLIVE ST
DES MOINES NM
88418
US

IV. Provider business mailing address

PO BOX 127
DES MOINES NM
88418-0127
US

V. Phone/Fax

Practice location:
  • Phone: 575-278-3911
  • Fax: 575-278-2106
Mailing address:
  • Phone: 575-278-2127
  • Fax: 575-278-2126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: MR. PAUL JOSEPH BRIESH JR.
Title or Position: EMS DIRECTOR
Credential: EMT - I
Phone: 575-278-2101