Healthcare Provider Details

I. General information

NPI: 1891847646
Provider Name (Legal Business Name): THOMAS J HABIGER EMT-I
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1213 PEEL ST
GRANTS NM
87020-3511
US

IV. Provider business mailing address

PO BOX 1921
GRANTS NM
87020-1921
US

V. Phone/Fax

Practice location:
  • Phone: 505-287-8708
  • Fax: 505-287-5160
Mailing address:
  • Phone: 505-287-2289
  • Fax: 505-287-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number00023539
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: