Provider Demographics
NPI:1457851016
Name:FRIENDS OF MOUNT TAYLOR AMBULANCE
Entity Type:Organization
Organization Name:FRIENDS OF MOUNT TAYLOR AMBULANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:E
Authorized Official - Last Name:HABIGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-287-2289
Mailing Address - Street 1:PO BOX 1786
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020-1786
Mailing Address - Country:US
Mailing Address - Phone:505-287-2289
Mailing Address - Fax:
Practice Address - Street 1:1213 PEEL ST
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020-3511
Practice Address - Country:US
Practice Address - Phone:505-287-2289
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-20
Last Update Date:2018-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance