MEDICARE: QUALITY MINERS HEALTHCARE LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies
2	332BX2000X	Oxygen Equipment & Supplies (DME)
3	251E00000X	Home Health Agency	3461	NM

General Provider Information

NPI Number	:	1609293331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	QUALITY MINERS HEALTHCARE LLC

Provider Business Mailing Address
First Line	:	PO BOX 1718
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-1718
Country	:	US
Telephone Number	:	505-285-9861
Fax Number	:	888-972-4314

Provider Business Practice Location Address
First Line	:	409 N FIRST ST
Second Line	:
City	:	GRANTS
State	:	NM
Zip	:	87020-2544
Country	:	US
Telephone Number	:	505-285-9861
Fax Number	:	888-972-4314

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	RHONDA G MOORE
Credential	:	R.N.
Telephone Number	:	505-285-9861

Provider Enumeration Date	:	03/19/2014
Last Update Date	:	03/19/2014

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Directions to “QUALITY MINERS HEALTHCARE LLC ” Practice Location

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