NPIMap

Organization Active NPI

Village of Eagle Nest

Doing business as Eagle Nest Ambulance

  • Land Ambulance
  • Eagle Nest, NM
National Provider Identifier
1063531341
Registry record updated Sep 17, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Land AmbulanceTaxonomy code 3416L0300X
Legal business name
VILLAGE OF EAGLE NEST
Doing business as
Eagle Nest Ambulance
Practice address
74 Tomboy Dr.
Eagle Nest, NM 87718
Phone
(505) 377-0663
NPI assigned
Mar 28, 2007
Last updated
Sep 17, 2010By the provider in NPPES
Organization subpart
Yes
Parent organization
THE VILLAGE OF EAGLE NESTAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Sep 17, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Wayne Baker
Title
Billing Agent
Phone
(505) 376-2939

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Land Ambulance 3416L0300X Primary

Addresses

Primary practice location

74 Tomboy Dr.
Eagle Nest, NM 87718

Mailing address

74 Tomboy Dr.
Eagle Nest, NM 87718
Phone (505) 377-0663

Other identifiers 1

IdentifierTypeStateIssuer
R0837MedicaidNM

Other names 1

  • EAGLE NEST AMBULANCE Doing business as

National Provider Directory

National Provider Directory
Part of
Village of Eagle Nest

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1284681600000",
    "number": "1063531341",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "74 TOMBOY DR.",
            "city": "EAGLE NEST",
            "state": "NM",
            "postal_code": "87718",
            "telephone_number": "505-377-0663"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "74 TOMBOY DR.",
            "city": "EAGLE NEST",
            "state": "NM",
            "postal_code": "87718",
            "telephone_number": "505-377-0663"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VILLAGE OF EAGLE NEST",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "THE VILLAGE OF EAGLE NEST",
        "enumeration_date": "2007-03-28",
        "last_updated": "2010-09-17",
        "status": "A",
        "authorized_official_last_name": "BAKER",
        "authorized_official_first_name": "WAYNE",
        "authorized_official_title_or_position": "BILLING AGENT",
        "authorized_official_telephone_number": "505-376-2939",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "R0837",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "EAGLE NEST AMBULANCE",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Eagle Nest, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.