=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396183547
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SHUTTLE RUIDOSO, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/10/2013
-----------------------------------------------------
Last Update Date | 06/25/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1096 MECHEM DR STE 312
-----------------------------------------------------
City | RUIDOSO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-257-1815
-----------------------------------------------------
Fax | 575-257-1816
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1096 MECHEM DR STE 312
-----------------------------------------------------
City | RUIDOSO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88345
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-257-1815
-----------------------------------------------------
Fax | 575-257-1816
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | MR. DAVID R CASON II
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-973-4079
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 343900000X
-----------------------------------------------------
Taxonomy Name | Non-emergency Medical Transport (VAN)
-----------------------------------------------------
License Number | NMPRC 54678
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------