Healthcare Provider Details

I. General information

NPI: 1487711578
Provider Name (Legal Business Name): SUPERIOR AMBULANCE OF TORRANCE COUNTY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2007
Last Update Date: 11/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 CARL CANNON RD
MORIARITY NM
87035
US

IV. Provider business mailing address

PO BOX 6913
ALBUQUERQUE NM
87197-6913
US

V. Phone/Fax

Practice location:
  • Phone: 505-247-8840
  • Fax: 505-830-1260
Mailing address:
  • Phone: 505-247-8840
  • Fax: 505-830-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number131132
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number131132
License Number StateNM

VIII. Authorized Official

Name: CHRIS L ARCHULETA
Title or Position: PRESIDENT
Credential:
Phone: 505-247-8840