Healthcare Provider Details

I. General information

NPI: 1629951702
Provider Name (Legal Business Name): OPEN RANGE MEDICAL SUPPLY INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2025
Last Update Date: 07/28/2025
Certification Date: 07/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 PASEO DE PERALTA
SANTA FE NM
87501-1938
US

IV. Provider business mailing address

405 PASEO DE PERALTA
SANTA FE NM
87501-1938
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-6977
  • Fax: 505-772-9077
Mailing address:
  • Phone: 831-454-6977
  • Fax: 505-772-9077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: NAOMI LEGATE
Title or Position: OWNER-NURSE PRACTITIONER
Credential: CNP
Phone: 505-531-0202