Town of Cochiti Lake

Primary specialty

Land AmbulanceTaxonomy code 3416L0300X

Legal business name

TOWN OF COCHITI LAKE

Practice address

6515C Hoochaneetsa Blvd
Cochiti Lake, NM 87083-6031

Phone

(505) 465-2421

NPI assigned

Nov 18, 2006

Last updated

Sep 21, 2017By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. John W Gurule

Title

Chief

Phone

(505) 697-0484

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Isaac Smith-Covarrubias, NRP

  • Paramedic
  • Cochiti Lake, NM
  • NPI 1215893847
  NPD (past)

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

{
    "created_epoch": "1163808000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1505952000000",
    "number": "1558435990",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 641880",
            "city": "OMAHA",
            "state": "NE",
            "postal_code": "681647880",
            "telephone_number": "402-572-4019",
            "fax_number": "888-506-4589"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6515C HOOCHANEETSA BLVD",
            "city": "COCHITI LAKE",
            "state": "NM",
            "postal_code": "870836031",
            "telephone_number": "505-465-2421"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TOWN OF COCHITI LAKE",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-18",
        "last_updated": "2017-09-21",
        "status": "A",
        "authorized_official_last_name": "GURULE",
        "authorized_official_first_name": "JOHN",
        "authorized_official_middle_name": "W",
        "authorized_official_title_or_position": "CHIEF",
        "authorized_official_telephone_number": "505-697-0484",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "3416L0300X",
            "taxonomy_group": "",
            "desc": "Ambulance, Land Transport",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "P4704",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lena Bennet LCSW LLC
• Kristina M March, LPCC
• National Latino Behavioral Health Association
• Isaac Smith-Covarrubias, NRP
• Sandra J Wise, LMT

• Land Ambulance in Cochiti Lake, NM
• Providers in Cochiti Lake, NM by specialty
• Land Ambulance in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.