Healthcare Provider Details

I. General information

NPI: 1700992617
Provider Name (Legal Business Name): THOREAU AMBULANCE SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 05/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#65 FIRST ST
THOREAU NM
87323
US

IV. Provider business mailing address

PO BOX 1115
THOREAU NM
87323-1115
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-7482
  • Fax: 505-863-7486
Mailing address:
  • Phone: 505-862-7482
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number19999
License Number StateNM

VIII. Authorized Official

Name: KENNETH HOFFMAN
Title or Position: EMS CHIEF
Credential:
Phone: 505-862-7482