MEDICARE: CITY OF SANTA ROSA

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	PRC13478	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	:	1306839253
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITY OF SANTA ROSA

Provider Business Mailing Address
First Line	:	PO BOX 18230
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-0230
Country	:	US
Telephone Number	:	505-472-3404
Fax Number	:

Provider Business Practice Location Address
First Line	:	141 S 5TH ST
Second Line	:
City	:	SANTA ROSA
State	:	NM
Zip	:	88435-2369
Country	:	US
Telephone Number	:	505-472-3404
Fax Number	:

Authorized Official
Title or Position	:	EMS CLERK
Name	:	MR. KEVIN ORTIZ
Credential	:
Telephone Number	:	575-472-0367

Provider Enumeration Date	:	08/25/2005
Last Update Date	:	11/03/2022

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Directions to “CITY OF SANTA ROSA ” Practice Location

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