Organization
904 WEST MAIN LLC
Active
Other names
Direct Medical Transport
Organization subpart
No
Provider details
NPI number
Authorized official
KURT COOK (OWNER)
(505) 793-6750
Entity
Organization
Contact information
Practice address
130 AIRPORT DR STE B, FARMINGTON, NM 87401-5520
(505) 793-6750
Mailing address
130 AIRPORT DR STE B, FARMINGTON, NM 87401-5520
(505) 793-6750
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Enumeration date
03/14/2023
Last updated
09/02/2024
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