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General NPI Number Information
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NPI Number | 1700992617
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Entity Type | Organization
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Legal Business Name | THOREAU AMBULANCE SERVICE
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Dates
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Enumeration Date | 08/22/2006
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Last Update Date | 05/31/2012
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Provider Practice Location Address
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Address Line | #65 FIRST ST
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City | THOREAU
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State | NM
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Zip | 87323
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Country | US
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Telephone | 505-862-7482
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Fax | 505-863-7486
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Provider Business Mailing Address
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Address Line | PO BOX 1115
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City | THOREAU
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State | NM
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Zip | 87323-1115
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Country | US
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Telephone | 505-862-7482
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Fax |
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Authorized Official
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Title or Position | EMS CHIEF
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Name | KENNETH HOFFMAN
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Credential |
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Telephone | 505-862-7482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 341600000X
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Taxonomy Name | Ambulance
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License Number | 19999
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License Number State | NM
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