Healthcare Provider Details

I. General information

NPI: 1891910295
Provider Name (Legal Business Name): PECOS VALLEY AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 HWY 50
PECOS NM
87552-0710
US

IV. Provider business mailing address

PO BOX 710 HWY 50
PECOS NM
87552-0710
US

V. Phone/Fax

Practice location:
  • Phone: 505-757-6482
  • Fax: 505-757-2700
Mailing address:
  • Phone: 505-757-6482
  • Fax: 505-757-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: SIGRID OLSON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 505-757-6482