Provider Demographics
NPI:1922170620
Name:VILLAGE OF MAGDALENA
Entity Type:Organization
Organization Name:VILLAGE OF MAGDALENA
Other - Org Name:MAGDALENA VOLUNTEER FIRE DEPARTMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLERK/TREASURER
Authorized Official - Prefix:MR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:E
Authorized Official - Last Name:FINCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-854-2261
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-965-8594
Practice Address - Street 1:700 1ST STREET
Practice Address - Street 2:
Practice Address - City:MAGDALENA
Practice Address - State:NM
Practice Address - Zip Code:87825-1141
Practice Address - Country:US
Practice Address - Phone:402-572-4019
Practice Address - Fax:402-965-8594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2017-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMSCC 528883416L0300X
NM528883416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMPENDINGOtherBLUE CROSS BLUE SHIELD
NM96082364Medicaid
NMPENDINGOtherBLUE CROSS BLUE SHIELD