Healthcare Provider Details

I. General information

NPI: 1871691030
Provider Name (Legal Business Name): CITY OF SOCORRO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 04/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 SCHOOL OF MINES RD
SOCORRO NM
87801-4533
US

IV. Provider business mailing address

PO BOX K
SOCORRO NM
87801-0329
US

V. Phone/Fax

Practice location:
  • Phone: 505-835-3969
  • Fax:
Mailing address:
  • Phone: 505-835-0240
  • Fax: 505-838-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License NumberSCC1575
License Number StateNM

VIII. Authorized Official

Name: MR. RAVI BHASKER
Title or Position: MAYOR
Credential: M.D.
Phone: 505-835-0240