Healthcare Provider Details

I. General information

NPI: 1386985331
Provider Name (Legal Business Name): SHI'MA INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2013
Last Update Date: 03/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 PADRE CAYON RD
REHOBOTH NM
87322
US

IV. Provider business mailing address

PO BOX 141
REHOBOTH NM
87322
US

V. Phone/Fax

Practice location:
  • Phone: 505-879-0110
  • Fax:
Mailing address:
  • Phone: 505-879-0110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSTILL IN PROGRESS
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberSTILL IN PROGRESS
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSTILL IN PROGRESS
License Number StateNM
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberSTILL IN PROGRESS
License Number StateAZ
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberSTILL IN PROGRESS
License Number StateAZ
# 6
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License NumberSTILL IN PROGRESS
License Number StateNM

VIII. Authorized Official

Name: TOMMY THOMPSON
Title or Position: OWNER
Credential:
Phone: 505-879-0110