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General NPI Number Information
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NPI Number | 1679716419
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Entity Type | Organization
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Legal Business Name | PUEBLO OF ACOMA
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Dates
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Enumeration Date | 04/09/2009
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Last Update Date | 04/25/2025
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Provider Practice Location Address
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Address Line | 74 PINSBAARI DR
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City | ACOMA
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State | NM
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Zip | 87034-1001
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Country | US
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Telephone | 505-552-7500
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Fax | 505-552-9470
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Provider Business Mailing Address
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Address Line | PO BOX 641880
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City | OMAHA
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State | NE
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Zip | 68164-7880
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Country | US
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Telephone | 402-991-7866
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Fax | 505-552-9470
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Authorized Official
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Title or Position | AGENT
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Name | MR. BARBARA A VAUGHN
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Credential |
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Telephone | 402-991-7866
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 54980
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License Number State | NM
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