MEDICARE: CITY OF RATON

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	590005125	OTHER	NM	RRMC PROVIDER NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	00NM00R018	OTHER	NM	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1265518245
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF RATON

Provider Business Mailing Address
First Line	:	PO BOX 910
Second Line	:
City	:	RATON
State	:	NM
Zip	:	87740-0910
Country	:	US
Telephone Number	:	575-445-2708
Fax Number	:	575-445-2709

Provider Business Practice Location Address
First Line	:	127 CLARK AVE
Second Line	:
City	:	RATON
State	:	NM
Zip	:	87740
Country	:	US
Telephone Number	:	575-445-2708
Fax Number	:	575-445-2709

Authorized Official
Title or Position	:	EMS CHIEF
Name	:	DUSTY RUSSELL
Credential	:
Telephone Number	:	575-445-2708

Provider Enumeration Date	:	10/31/2006
Last Update Date	:	03/06/2026

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Directions to “CITY OF RATON ” Practice Location

Language	Start Address	Practice Location

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