Organization
VILLAGE OF EAGLE NEST
Active
Parent organization
THE VILLAGE OF EAGLE NEST
Other names
EAGLE NEST AMBULANCE
Organization subpart
Yes
Provider details
NPI number
Legal business name
THE VILLAGE OF EAGLE NEST
Authorized official
MR. WAYNE BAKER (BILLING AGENT)
(505) 376-2939
Entity
Organization
Contact information
Practice address
74 TOMBOY DR., EAGLE NEST, NM 87718
(505) 377-0663
Mailing address
74 TOMBOY DR., EAGLE NEST, NM 87718
(505) 377-0663
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R0837
—
NM
Enumeration date
03/28/2007
Last updated
09/17/2010
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