Healthcare Provider Details

I. General information

NPI: 1457493934
Provider Name (Legal Business Name): CITY OF EUNICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/13/2007
Last Update Date: 04/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1107 AVENUE J
EUNICE NM
88231
US

IV. Provider business mailing address

PO BOX 747
EUNICE NM
88231-0747
US

V. Phone/Fax

Practice location:
  • Phone: 575-394-3258
  • Fax: 575-394-3495
Mailing address:
  • Phone: 575-394-3258
  • Fax: 575-394-3495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number12493
License Number StateNM

VIII. Authorized Official

Name: MR. JESSE N DAVIS
Title or Position: EMS DIVISION CHIEF
Credential: NRP
Phone: 575-394-3258