MEDICARE: INCORPORATED COUNTY OF LOS ALAMOS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3416L0300X	Land Ambulance	41036	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	201080137	OTHER	NM	PRESBYTERIAN SALUD
2	4074870	OTHER		BLUE CROSS/BLUE SHIELD
3	G008A95	OTHER		MUTUAL OF OMAHA
4	00NM00R031	OTHER		BLUE CROSS/BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	3142	OTHER		KAISER PERMANENTE
7	201080137	OTHER		PRESBYTERIAN INSURANCE C
8	13847	OTHER		PRESBYTERIAN HEALTH PLAN

General Provider Information

NPI Number	:	1033142443
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INCORPORATED COUNTY OF LOS ALAMOS

Provider Business Mailing Address
First Line	:	999 CENTRAL AVE STE 200
Second Line	:
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3328
Country	:	US
Telephone Number	:	505-662-8318
Fax Number	:	505-662-8302

Provider Business Practice Location Address
First Line	:	999 CENTRAL AVE
Second Line	:	SUITE 200
City	:	LOS ALAMOS
State	:	NM
Zip	:	87544-3330
Country	:	US
Telephone Number	:	505-662-8318
Fax Number	:	505-662-8302

Authorized Official
Title or Position	:	CHIEF FINANCIAL OFFICER
Name	:	MELISSA DADZIE
Credential	:
Telephone Number	:	505-662-8018

Provider Enumeration Date	:	07/09/2006
Last Update Date	:	02/16/2026

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Directions to “INCORPORATED COUNTY OF LOS ALAMOS ” Practice Location

Language	Start Address	Practice Location

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