=====================================================
General NPI Number Information
=====================================================
NPI Number | 1447344585
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TOWN OF CLAYTON
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/03/2006
-----------------------------------------------------
Last Update Date | 05/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 CHESTNUT STREET
-----------------------------------------------------
City | CLAYTON
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 88415
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-374-8331
-----------------------------------------------------
Fax | 505-374-8497
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10802 FARNAM DR
-----------------------------------------------------
City | OMAHA
-----------------------------------------------------
State | NE
-----------------------------------------------------
Zip | 68154-3237
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 531-895-5853
-----------------------------------------------------
Fax | 877-343-0131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLERK TREASURER
-----------------------------------------------------
Name | KATHERINE BARNES
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 575-374-8331
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3416L0300X
-----------------------------------------------------
Taxonomy Name | Land Ambulance
-----------------------------------------------------
License Number | 14760
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------