Provider Demographics
NPI:1841588506
Name:SAINT MARY NONEMERGENCY MEDICAL TRANSPORTATIO
Entity Type:Organization
Organization Name:SAINT MARY NONEMERGENCY MEDICAL TRANSPORTATIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DELMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-515-4149
Mailing Address - Street 1:1325 SADDLEHORN TRAIL
Mailing Address - Street 2:
Mailing Address - City:GRANTS
Mailing Address - State:NM
Mailing Address - Zip Code:87020
Mailing Address - Country:US
Mailing Address - Phone:505-515-4149
Mailing Address - Fax:
Practice Address - Street 1:1325 SADDLEHORN TRAIL
Practice Address - Street 2:
Practice Address - City:GRANTS
Practice Address - State:NM
Practice Address - Zip Code:87020
Practice Address - Country:US
Practice Address - Phone:505-515-4149
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SAINT MARY NONEMERGENCY MEDICAL TRANSPORATION, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-07-15
Last Update Date:2011-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)