Provider Demographics
NPI:1043641558
Name:MESCALERO APACHE TRIBE
Entity Type:Organization
Organization Name:MESCALERO APACHE TRIBE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:NUNNALLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-973-4371
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:MESCALERO
Mailing Address - State:NM
Mailing Address - Zip Code:88340-0070
Mailing Address - Country:US
Mailing Address - Phone:575-464-3473
Mailing Address - Fax:575-464-3474
Practice Address - Street 1:25220 HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:MESCALERO
Practice Address - State:NM
Practice Address - Zip Code:88340
Practice Address - Country:US
Practice Address - Phone:575-464-3473
Practice Address - Fax:575-464-3474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-09
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport