Healthcare Provider Details

I. General information

NPI: 1356470447
Provider Name (Legal Business Name): VILLAGE OF FORT SUMNER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 11/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

173 E AVE C
FT SUMNER NM
88119
US

IV. Provider business mailing address

PO BOX 180
FORT SUMNER NM
88119-0180
US

V. Phone/Fax

Practice location:
  • Phone: 575-355-2401
  • Fax:
Mailing address:
  • Phone: 575-355-2401
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State

VIII. Authorized Official

Name: BONNIE LILLY
Title or Position: ADMINISTRATOR
Credential:
Phone: 575-355-2401