Provider Demographics
NPI:1275648644
Name:VILLAGE OF CIMARRON
Entity Type:Organization
Organization Name:VILLAGE OF CIMARRON
Other - Org Name:CIMARRON COMMUNITY AMBULANCE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EMS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:LAY
Authorized Official - Suffix:
Authorized Official - Credentials:PARAMEDIC
Authorized Official - Phone:575-376-2281
Mailing Address - Street 1:PO BOX 654
Mailing Address - Street 2:
Mailing Address - City:CIMARRON
Mailing Address - State:NM
Mailing Address - Zip Code:87714-0654
Mailing Address - Country:US
Mailing Address - Phone:505-376-2281
Mailing Address - Fax:
Practice Address - Street 1:356 B EAST 9TH STREET
Practice Address - Street 2:
Practice Address - City:CIMARRON
Practice Address - State:NM
Practice Address - Zip Code:87714
Practice Address - Country:US
Practice Address - Phone:575-376-2232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR2643Medicaid
NMR2643Medicaid