Provider Demographics
NPI:1871691030
Name:CITY OF SOCORRO
Entity Type:Organization
Organization Name:CITY OF SOCORRO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MAYOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RAVI
Authorized Official - Middle Name:
Authorized Official - Last Name:BHASKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-835-0240
Mailing Address - Street 1:PO BOX K
Mailing Address - Street 2:
Mailing Address - City:SOCORRO
Mailing Address - State:NM
Mailing Address - Zip Code:87801-0329
Mailing Address - Country:US
Mailing Address - Phone:505-835-0240
Mailing Address - Fax:505-838-4027
Practice Address - Street 1:111 SCHOOL OF MINES RD
Practice Address - Street 2:
Practice Address - City:SOCORRO
Practice Address - State:NM
Practice Address - Zip Code:87801-4533
Practice Address - Country:US
Practice Address - Phone:505-835-3969
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSCC1575341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR090OtherBLUE CROSS BLUE SHIELD
NMR1942Medicaid
NM590005059OtherPALMETTO GBA
NM2500236Medicare ID - Type UnspecifiedMEDICARE