Healthcare Provider Details

I. General information

NPI: 1245688647
Provider Name (Legal Business Name): RIO MEDICAL TRANSPORT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2016
Last Update Date: 05/26/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 MANHATTAN PARK DR
SANTA CLARA NM
88026
US

IV. Provider business mailing address

P O BOX 421
SANTA CLARA NM
88026
US

V. Phone/Fax

Practice location:
  • Phone: 520-260-6818
  • Fax:
Mailing address:
  • Phone: 520-260-6818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: LYNN D GUNWALL
Title or Position: GENERAL MANAGER
Credential:
Phone: 520-260-6818