Provider Demographics
NPI:1740408756
Name:VILLAGE OF SAN JON
Entity Type:Organization
Organization Name:VILLAGE OF SAN JON
Other - Org Name:SAN JON COOPERATIVE AMBULANCE
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICIAL
Authorized Official - Prefix:MR
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:STONER
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-I
Authorized Official - Phone:575-403-8463
Mailing Address - Street 1:10802 FARNAM DR
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3237
Mailing Address - Country:US
Mailing Address - Phone:877-218-4392
Mailing Address - Fax:877-343-0131
Practice Address - Street 1:414 E. ELM
Practice Address - Street 2:
Practice Address - City:SAN JON
Practice Address - State:NM
Practice Address - Zip Code:88434
Practice Address - Country:US
Practice Address - Phone:505-576-2922
Practice Address - Fax:505-576-2722
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM026903416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM02690OtherSTATE LICENSE