Healthcare Provider Details

I. General information

NPI: 1780708081
Provider Name (Legal Business Name): SOCORRO TAXI INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 08/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

606 N. CALIFORNIA ST
SOCORRO NM
87801-5021
US

IV. Provider business mailing address

606 N. CALIFORNIA ST
SOCORRO NM
87801-5021
US

V. Phone/Fax

Practice location:
  • Phone: 575-835-2678
  • Fax: 575-838-2203
Mailing address:
  • Phone: 575-835-2678
  • Fax: 575-838-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number51925
License Number StateNM

VIII. Authorized Official

Name: MR. JESS D LANDERS
Title or Position: OWNER
Credential:
Phone: 575-835-2678