Healthcare Provider Details

I. General information

NPI: 1861593774
Provider Name (Legal Business Name): PECOS VALLEY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

523 HWY 50
PECOS NM
87552-0710
US

IV. Provider business mailing address

PO BOX 710
PECOS NM
87552-0710
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-6333
  • Fax:
Mailing address:
  • Phone: 505-757-6333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number06416
License Number StateNM

VIII. Authorized Official

Name: ASHLEY D. YOUNG-COX
Title or Position: DIRECTOR
Credential: PARAMEDIC
Phone: 505-757-6333