Provider Demographics
NPI:1043348840
Name:MORIARTY FIRE DEPARTMENT
Entity Type:Organization
Organization Name:MORIARTY FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SPANN
Authorized Official - Suffix:
Authorized Official - Credentials:NREMT-PARAMEDIC
Authorized Official - Phone:505-832-4301
Mailing Address - Street 1:PO BOX 130
Mailing Address - Street 2:201 BROADWAY
Mailing Address - City:MORIARTY
Mailing Address - State:NM
Mailing Address - Zip Code:87035-0130
Mailing Address - Country:US
Mailing Address - Phone:505-832-4301
Mailing Address - Fax:505-832-9724
Practice Address - Street 1:201 BROADWAY
Practice Address - Street 2:
Practice Address - City:MORIARTY
Practice Address - State:NM
Practice Address - Zip Code:87035-0130
Practice Address - Country:US
Practice Address - Phone:505-832-4301
Practice Address - Fax:505-832-9724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM68265341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance