Provider Demographics
NPI:1215194493
Name:TOWN OF VAUGHN
Entity Type:Organization
Organization Name:TOWN OF VAUGHN
Other - Org Name:TOWN OF VAUGHN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHALINE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-584-2301
Mailing Address - Street 1:P.O. BOX 278
Mailing Address - Street 2:
Mailing Address - City:VAUGHN
Mailing Address - State:NM
Mailing Address - Zip Code:88353
Mailing Address - Country:US
Mailing Address - Phone:575-584-2301
Mailing Address - Fax:575-584-2940
Practice Address - Street 1:322 E. 8TH STREET
Practice Address - Street 2:
Practice Address - City:VAUGHN
Practice Address - State:NM
Practice Address - Zip Code:88353
Practice Address - Country:US
Practice Address - Phone:575-584-2301
Practice Address - Fax:575-584-2940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-16
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03113593416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000R1637Medicaid
2503664Medicare PIN