Healthcare Provider Details

I. General information

NPI: 1285887687
Provider Name (Legal Business Name): ELIDA FIRE DEPARTMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2008
Last Update Date: 10/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 US 70
ELIDA NM
88116-0208
US

IV. Provider business mailing address

704 CLARK STREET P.O. BOX 208
ELIDA NM
88116-0208
US

V. Phone/Fax

Practice location:
  • Phone: 575-274-6465
  • Fax:
Mailing address:
  • Phone: 575-274-6465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number0323360
License Number StateNM

VIII. Authorized Official

Name: MR. ADAM L ANTHONY
Title or Position: CHIEF
Credential:
Phone: 575-274-6465