Organization
FOUR CORNERS TRANSPORTATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RYLUS LEE (OWNER)
(505) 947-1531
Entity
Organization
Contact information
Practice address
700 ALISE AVE, FARMINGTON, NM 87401-5726
(505) 947-1531
Mailing address
PO BOX 6505, FARMINGTON, NM 87499-6505
Taxonomy
Speciality
Code
Description
License number
State
343900000X
Non-emergency Medical Transport (VAN)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
96058749
—
NM
Enumeration date
02/28/2018
Last updated
02/28/2018
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