=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295779312
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COUNTY OF CATRON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2006
-----------------------------------------------------
Last Update Date | 07/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 100 MAIN STREET
-----------------------------------------------------
City | RESERVE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87830-0507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-533-6423
-----------------------------------------------------
Fax | 575-533-6433
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 507
-----------------------------------------------------
City | RESERVE
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87830-0507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-533-6423
-----------------------------------------------------
Fax | 575-533-6433
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COUNTY MANAGER
-----------------------------------------------------
Name | MR. WILLIAM AYMAR
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-533-6423
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------