Provider Demographics
NPI:1639167497
Name:TOWN OF TATUM
Entity Type:Organization
Organization Name:TOWN OF TATUM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:E
Authorized Official - Last Name:RAMBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-398-4633
Mailing Address - Street 1:PO BOX 156
Mailing Address - Street 2:
Mailing Address - City:TATUM
Mailing Address - State:NM
Mailing Address - Zip Code:88267-0156
Mailing Address - Country:US
Mailing Address - Phone:505-398-4633
Mailing Address - Fax:505-398-8288
Practice Address - Street 1:401 E BROADWAY
Practice Address - Street 2:
Practice Address - City:TATUM
Practice Address - State:NM
Practice Address - Zip Code:88267-0156
Practice Address - Country:US
Practice Address - Phone:505-398-4633
Practice Address - Fax:505-398-8288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR0381Medicaid
NMR0381Medicaid