Healthcare Provider Details

I. General information

NPI: 1306284682
Provider Name (Legal Business Name): CITY OF MORIARTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/10/2013
Last Update Date: 06/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 BROADWAY SE
MORIARTY NM
87035
US

IV. Provider business mailing address

PO BOX 641880
OMAHA NE
68164-7880
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-4301
  • Fax:
Mailing address:
  • Phone: 402-572-4019
  • Fax: 402-991-0719

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number68265
License Number StateNM

VIII. Authorized Official

Name: STEVEN SPANN
Title or Position: FIRE CHIEF
Credential:
Phone: 505-832-4301