Organization
TOWN OF COCHITI LAKE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JOHN W GURULE (CHIEF)
(505) 697-0484
Entity
Organization
Contact information
Practice address
6515C HOOCHANEETSA BLVD, COCHITI LAKE, NM 87083-6031
(505) 465-2421
Mailing address
PO BOX 641880, OMAHA, NE 68164-7880
(402) 572-4019
(888) 506-4589
Taxonomy
Speciality
Code
Description
License number
State
3416L0300X
Land Ambulance
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
P4704
—
NM
Enumeration date
11/18/2006
Last updated
09/21/2017
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