MEDICARE: CAMILLES 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	1744P3200X	Prosthetics Case Management	01824808000	NM

General Provider Information

NPI Number	:	1770631376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CAMILLES INC

Provider Business Mailing Address
First Line	:	1625 SAN PEDRO NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-6733
Country	:	US
Telephone Number	:	505-268-2770
Fax Number	:	505-265-2355

Provider Business Practice Location Address
First Line	:	1625 SAN PEDRO NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87110-6733
Country	:	US
Telephone Number	:	505-268-2770
Fax Number	:	505-265-2355

Authorized Official
Title or Position	:	OWNER MANAGER
Name	:	MRS. JUDY KAY WINGATE
Credential	:
Telephone Number	:	505-268-2770

Provider Enumeration Date	:	01/08/2007
Last Update Date	:	05/15/2008

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