MEDICARE: MR. RAMON J SALAS CPO

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	282N00000X	General Acute Care Hospital

General Provider Information

NPI Number	:	1629182753
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. RAMON J SALAS CPO

Provider Business Mailing Address
First Line	:	2616 STEVENS DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1562
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2616 STEVENS DR NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87112-1562
Country	:	US
Telephone Number	:	505-653-3206
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/18/2006
Last Update Date	:	07/08/2007

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