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General NPI Number Information
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NPI Number | 1952585184
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Entity Type | Organization
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Legal Business Name | BRAZOS VALLEY CARDIO RESPIRATORY
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Dates
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Enumeration Date | 12/24/2007
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Last Update Date | 04/09/2009
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Provider Practice Location Address
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Address Line | 141-A MESCALERO TR.
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City | RUIDOSO
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State | NM
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Zip | 88345
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Country | US
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Telephone | 575-257-5083
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Fax | 575-257-5083
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Provider Business Mailing Address
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Address Line | 141-A MESCALERO TR.
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City | RUIDOSO
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State | NM
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Zip | 88345
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Country | US
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Telephone | 575-257-5083
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Fax | 575-257-5083
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Authorized Official
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Title or Position | OWNER
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Name | MR. KEVIN E MILLER
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Credential | RRT/RCP
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Telephone | 575-257-5083
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 293D00000X
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Taxonomy Name | Physiological Laboratory
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License Number | 56124
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 332BX2000X
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Taxonomy Name | Oxygen Equipment & Supplies (DME)
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License Number | 0059159
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License Number State | TX
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