Provider Demographics
NPI:1891910295
Name:PECOS VALLEY AMBULANCE SERVICE
Entity Type:Organization
Organization Name:PECOS VALLEY AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SIGRID
Authorized Official - Middle Name:
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-757-6482
Mailing Address - Street 1:PO BOX 710
Mailing Address - Street 2:HWY 50
Mailing Address - City:PECOS
Mailing Address - State:NM
Mailing Address - Zip Code:87552-0710
Mailing Address - Country:US
Mailing Address - Phone:505-757-6482
Mailing Address - Fax:505-757-2700
Practice Address - Street 1:521 HWY 50
Practice Address - Street 2:
Practice Address - City:PECOS
Practice Address - State:NM
Practice Address - Zip Code:87552-0710
Practice Address - Country:US
Practice Address - Phone:505-757-6482
Practice Address - Fax:505-757-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMRO522Medicaid