Provider Demographics
NPI:1043382427
Name:CITY OF TUCUMCARI
Entity Type:Organization
Organization Name:CITY OF TUCUMCARI
Other - Org Name:TUCUMCARI MEDICAL SERVICES DEPT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:RIVALE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-461-2558
Mailing Address - Street 1:PO BOX 1188
Mailing Address - Street 2:
Mailing Address - City:TUCUMCARI
Mailing Address - State:NM
Mailing Address - Zip Code:88401-1188
Mailing Address - Country:US
Mailing Address - Phone:505-461-2558
Mailing Address - Fax:505-461-2561
Practice Address - Street 1:225 E CENTER ST
Practice Address - Street 2:
Practice Address - City:TUCUMCARI
Practice Address - State:NM
Practice Address - Zip Code:88401-2214
Practice Address - Country:US
Practice Address - Phone:505-461-2558
Practice Address - Fax:505-461-2561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM27543416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM800521041Medicare ID - Type Unspecified