Healthcare Provider Details

I. General information

NPI: 1790973329
Provider Name (Legal Business Name): THOMAS J HABIGER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2007
Last Update Date: 10/16/2007
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: 505-287-7446
Mailing address:
  • Phone: 505-287-2289
  • Fax: 505-287-5160

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number01938
License Number StateNM

VIII. Authorized Official

Name: MR. THOMAS J HABIGER
Title or Position: OWNER
Credential: EMT-I
Phone: 505-287-2289