=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871691030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF SOCORRO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/20/2006
-----------------------------------------------------
Last Update Date | 04/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 111 SCHOOL OF MINES RD
-----------------------------------------------------
City | SOCORRO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87801-4533
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-835-3969
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX K
-----------------------------------------------------
City | SOCORRO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87801-0329
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 505-835-0240
-----------------------------------------------------
Fax | 505-838-4027
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MAYOR
-----------------------------------------------------
Name | MR. RAVI BHASKER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 505-835-0240
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 341600000X
-----------------------------------------------------
Taxonomy Name | Ambulance
-----------------------------------------------------
License Number | SCC1575
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------