MEDICARE: RUNNING BEAR RESCUE,INC.

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	BR7078478	NM

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104980176
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUNNING BEAR RESCUE,INC.

Provider Business Mailing Address
First Line	:	PO BOX 641880
Second Line	:
City	:	OMAHA
State	:	NE
Zip	:	68164-7880
Country	:	US
Telephone Number	:	402-572-4019
Fax Number	:

Provider Business Practice Location Address
First Line	:	1660 OLD PECOS TRL
Second Line	:	SUITE F
City	:	SANTA FE
State	:	NM
Zip	:	87505-4779
Country	:	US
Telephone Number	:	505-328-6269
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	EDWARD LITTLE
Credential	:
Telephone Number	:	505-328-6269

Provider Enumeration Date	:	12/21/2006
Last Update Date	:	04/11/2012

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Directions to “RUNNING BEAR RESCUE,INC. ” Practice Location

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