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General NPI Number Information
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NPI Number | 1568613768
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Entity Type | Organization
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Legal Business Name | AMISTAD-HAYDEN AMBULANCE SERVICE
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 771 TOMPKINS RD
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City | AMISTAD
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State | NM
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Zip | 88410-6225
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Country | US
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Telephone | 575-633-2858
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Fax |
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Provider Business Mailing Address
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Address Line | 771 TOMPKINS RD
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City | AMISTAD
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State | NM
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Zip | 88410-6225
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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 | COORDINATOR
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Name | HELEN THOMPKINS
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Credential |
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Telephone | 575-633-2858
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QE0002X
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Taxonomy Name | Emergency Care Clinic/Center
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License Number | 1147578
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License Number State | NM
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