Healthcare Provider Details

I. General information

NPI: 1386768463
Provider Name (Legal Business Name): PUEBLO OF ZUNI EMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 04/20/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#04 THIRD STREET
ZUNI NM
87327-0339
US

IV. Provider business mailing address

#04 THIRD STREET P.O. BOX 339
ZUNI NM
87327-0339
US

V. Phone/Fax

Practice location:
  • Phone: 505-782-4833
  • Fax: 505-782-4591
Mailing address:
  • Phone:
  • Fax: 505-782-4591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number14437
License Number StateNM

VIII. Authorized Official

Name: EDWARD A SANCHEZ
Title or Position: CHIEF
Credential:
Phone: 505-782-4833