Healthcare Provider Details

I. General information

NPI: 1497814693
Provider Name (Legal Business Name): DEBORAH STUBBLEFIELD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2006
Last Update Date: 05/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

612 N DATE ST
TRUTH OR CONSEQUENCES NM
87901-1742
US

IV. Provider business mailing address

PO BOX 1309
TRUTH OR CONSEQUENCES NM
87901-1309
US

V. Phone/Fax

Practice location:
  • Phone: 505-894-6640
  • Fax: 505-894-9482
Mailing address:
  • Phone: 505-894-6640
  • Fax: 505-894-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number210
License Number StateNM

VIII. Authorized Official

Name: MRS. DEBORAH ANN STUBBLEFIELD
Title or Position: OWNER
Credential: RCP
Phone: 505-894-6640