Provider Demographics
NPI:1346561701
Name:COUNTY OF ROOSEVELT
Entity Type:Organization
Organization Name:COUNTY OF ROOSEVELT
Other - Org Name:MILNESAND VOLUNTEER FIRE DISTRICT AND ARCH VOLUNETEER FIRE DISTRICT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:A
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-356-5307
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-991-0719
Practice Address - Street 1:4607 NEW MEXICO 206
Practice Address - Street 2:
Practice Address - City:MILNESAND
Practice Address - State:NM
Practice Address - Zip Code:88125-9724
Practice Address - Country:US
Practice Address - Phone:575-675-2411
Practice Address - Fax:575-675-2379
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-18
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM52863341600000X, 3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance