Provider Demographics
NPI:1629191994
Name:TOWN OF HAGERMAN
Entity Type:Organization
Organization Name:TOWN OF HAGERMAN
Other - Org Name:HAGERMAN AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DPS DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CASSIUS
Authorized Official - Middle Name:G
Authorized Official - Last Name:MASON
Authorized Official - Suffix:III
Authorized Official - Credentials:DPS DIRECTOR - EMT-I
Authorized Official - Phone:505-752-3204
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:209 E ARGYLE
Mailing Address - City:HAGERMAN
Mailing Address - State:NM
Mailing Address - Zip Code:88232
Mailing Address - Country:US
Mailing Address - Phone:575-752-3204
Mailing Address - Fax:575-752-5400
Practice Address - Street 1:209 E ARGYLE
Practice Address - Street 2:
Practice Address - City:HAGERMAN
Practice Address - State:NM
Practice Address - Zip Code:88232
Practice Address - Country:US
Practice Address - Phone:575-752-3204
Practice Address - Fax:575-752-5400
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TOWN OF HAGERMAN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM240883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2507679OtherMEDICARE PROVIDER NUMBER