Healthcare Provider Details

I. General information

NPI: 1336155126
Provider Name (Legal Business Name): CITY OF PORTALES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 10/15/2024
Certification Date: 10/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S AVE C
PORTALES NM
88130
US

IV. Provider business mailing address

1028 COMMUNITY WAY
PORTALES NM
88130
US

V. Phone/Fax

Practice location:
  • Phone: 575-356-4406
  • Fax: 575-359-0925
Mailing address:
  • Phone: 575-356-6662
  • Fax: 575-563-3158

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code341600000X
TaxonomyAmbulance
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number12434
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: DANIELLE SWOPES
Title or Position: CITY CLERK
Credential:
Phone: 575-356-3158