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General NPI Number Information
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NPI Number | 1801081492
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Entity Type | Organization
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Legal Business Name | ROSEBUD FIRE & RESCUE INC.
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 07/26/2008
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Provider Practice Location Address
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Address Line | 1361 BRAVO DOME HIGHWAY
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City | AMISTAD
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State | NM
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Zip | 88410
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Country | US
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Telephone | 505-673-2851
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Fax | 505-673-2423
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Provider Business Mailing Address
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Address Line | 250 BRAVO DOME HWY
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City | BUEYEROS
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State | NM
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Zip | 88415-7272
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Country | US
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Telephone | 505-673-2326
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Fax | 505-673-2423
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Authorized Official
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Title or Position | EMS COORDINATOR
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Name | MARY L CAMPBELL
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Credential | EMT-B
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Telephone | 505-673-2326
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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 | 312339
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License Number State | NM
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