Provider Demographics
NPI:1326025115
Name:VILLAGE OF DORA
Entity Type:Organization
Organization Name:VILLAGE OF DORA
Other - Org Name:VILLAGE OF DORA AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:FRAZE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-477-2411
Mailing Address - Street 1:PO BOX 308
Mailing Address - Street 2:220 AVE A
Mailing Address - City:DORA
Mailing Address - State:NM
Mailing Address - Zip Code:88115-0308
Mailing Address - Country:US
Mailing Address - Phone:575-477-2411
Mailing Address - Fax:575-477-2418
Practice Address - Street 1:220 AVE A
Practice Address - Street 2:
Practice Address - City:DORA
Practice Address - State:NM
Practice Address - Zip Code:88115-0308
Practice Address - Country:US
Practice Address - Phone:575-477-2411
Practice Address - Fax:575-477-2418
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM38200341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM323355OtherEMS SERVICE NO.
NM38200OtherSTATE SCC REG. AMB. SERV
NM323355OtherEMS SERVICE NO.