Provider Demographics
NPI:1710987680
Name:CITY OF ARTESIA
Entity Type:Organization
Organization Name:CITY OF ARTESIA
Other - Org Name:ARTESIA AMBULANCE SERVICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BILLING CLERK II
Authorized Official - Prefix:MRS
Authorized Official - First Name:KYLA
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALES
Authorized Official - Suffix:
Authorized Official - Credentials:CAC
Authorized Official - Phone:575-748-0880
Mailing Address - Street 1:PO BOX 1310
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88211
Mailing Address - Country:US
Mailing Address - Phone:575-746-2122
Mailing Address - Fax:575-746-3886
Practice Address - Street 1:3300 W MAIN ST
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88210
Practice Address - Country:US
Practice Address - Phone:575-748-0880
Practice Address - Fax:575-746-3886
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF ARTESIA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-21
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMNMPRC122253416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2504966Medicare PIN
NM2504966Medicare PIN