Healthcare Provider Details

I. General information

NPI: 1902169816
Provider Name (Legal Business Name): BADGER HEALTH CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 07/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 S 2ND ST STE A
RATON NM
87740-2209
US

IV. Provider business mailing address

1275 S 2ND ST STE A
RATON NM
87740-2209
US

V. Phone/Fax

Practice location:
  • Phone: 575-445-0075
  • Fax: 575-445-0081
Mailing address:
  • Phone: 575-445-0075
  • Fax: 575-445-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPH00003416
License Number StateNM
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: PATRICK SCHEELS
Title or Position: SECRETARY/OWNER
Credential:
Phone: 303-898-7183