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General NPI Number Information
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NPI Number | 1134465024
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Entity Type | Organization
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Legal Business Name | INDIGENOUS INNOVATIONS
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Dates
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Enumeration Date | 12/20/2012
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Last Update Date | 01/07/2013
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Provider Practice Location Address
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Address Line | 913 W APACHE ST
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City | FARMINGTON
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State | NM
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Zip | 87401-3899
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Country | US
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Telephone | 505-686-4903
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2885
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City | KIRTLAND
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State | NM
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Zip | 87417-2885
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL OWNER
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Name | MR. WALTER BARBER JR.
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Credential |
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Telephone | 505-686-4903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 343900000X
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Taxonomy Name | Non-emergency Medical Transport (VAN)
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License Number | NMPRC 56258
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License Number State | NM
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