Provider Demographics
NPI:1770631376
Name:CAMILLES INC
Entity Type:Organization
Organization Name:CAMILLES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WINGATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-268-2770
Mailing Address - Street 1:1625 SAN PEDRO NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-6733
Mailing Address - Country:US
Mailing Address - Phone:505-268-2770
Mailing Address - Fax:505-265-2355
Practice Address - Street 1:1625 SAN PEDRO NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-6733
Practice Address - Country:US
Practice Address - Phone:505-268-2770
Practice Address - Fax:505-265-2355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2008-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM018248080001744P3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1770631376Medicare UPIN
0291940001Medicare NSC