MEDICARE: NORTHERN NM MEDICAID TRANSPORTATION, 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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1972358349
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHERN NM MEDICAID TRANSPORTATION, LLC

Provider Business Mailing Address
First Line	:	1125 WHITTIER ST
Second Line	:
City	:	RATON
State	:	NM
Zip	:	87740-2340
Country	:	US
Telephone Number	:	575-447-1090
Fax Number	:	505-514-0742

Provider Business Practice Location Address
First Line	:	1125 WHITTIER ST
Second Line	:
City	:	RATON
State	:	NM
Zip	:	87740-2340
Country	:	US
Telephone Number	:	575-447-1090
Fax Number	:	505-514-0742

Authorized Official
Title or Position	:	SECRETARY
Name	:	MALISSA S COLANGELO
Credential	:
Telephone Number	:	575-447-1090

Provider Enumeration Date	:	04/19/2024
Last Update Date	:	03/18/2026

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