Organization
PORTALES HOME MEDICAL EQUIPMENT INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURIE RENE NUCKOLS (PRESIDENT)
(575) 356-0688
Entity
Organization
Contact information
Practice address
312 S. MAIN, PORTALES, NM 88130-5917
(575) 356-0688
Mailing address
312 S. MAIN, PORTALES, NM 88130-0600
(575) 356-0688
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
332B00000X
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
NMT28F
BCBS
NM
05
—
S8459
—
NM
Enumeration date
11/03/2006
Last updated
10/30/2008
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