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General NPI Number Information
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NPI Number | 1205854494
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Entity Type | Organization
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Legal Business Name | BLUE HORSESHOE, INC.
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Dates
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Enumeration Date | 07/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 315 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5892
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Country | US
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Telephone | 505-623-0799
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Fax | 505-627-6257
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Provider Business Mailing Address
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Address Line | 315 W COUNTRY CLUB RD
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City | ROSWELL
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State | NM
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Zip | 88201-5892
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Country | US
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Telephone | 505-623-0799
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Fax | 505-627-6257
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Authorized Official
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Title or Position | BILLING MANAGER
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Name | JACKI GAYLE BATES
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Credential |
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Telephone | 505-623-0799
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number | 0604031
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License Number State | NM
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