Zuni Medical Supply Enterprise

Primary specialty

Oxygen Equipment & Supplies (DME)Taxonomy code 332BX2000X

License

01103 Issued in NM

Legal business name

ZUNI MEDICAL SUPPLY ENTERPRISE

Practice address

Building 52 Route 301 North
Zuni, NM 87327-0339

Phone

(505) 782-2434

Fax

(505) 782-2457

NPI assigned

Jun 1, 2005

Last updated

Jun 18, 2012By 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

Arlen P. Quetawki

Title

Gov./Pres. Board of Directors

Phone

(505) 782-2434

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NM

Enrollment records 1

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

{
    "created_epoch": "1117584000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1339977600000",
    "number": "1780686907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 339",
            "city": "ZUNI",
            "state": "NM",
            "postal_code": "873270339",
            "telephone_number": "505-782-2434",
            "fax_number": "505-782-2457"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "BUILDING 52 ROUTE 301 NORTH",
            "city": "ZUNI",
            "state": "NM",
            "postal_code": "873270339",
            "telephone_number": "505-782-2434",
            "fax_number": "505-782-2457"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ZUNI MEDICAL SUPPLY ENTERPRISE",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-06-01",
        "last_updated": "2012-06-18",
        "status": "A",
        "authorized_official_last_name": "QUETAWKI",
        "authorized_official_first_name": "ARLEN",
        "authorized_official_middle_name": "P.",
        "authorized_official_title_or_position": "GOV./PRES. BOARD OF DIRECTORS",
        "authorized_official_telephone_number": "505-782-2434"
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "NM",
            "license": "01103",
            "primary": false
        },
        {
            "code": "332BX2000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies, Oxygen Equipment & Supplies",
            "state": "NM",
            "license": "01103",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "T1046",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zuni Audiology Program
• Zuni Entrepreneurial Enterprises
• Zuni Home Health Care Agency
• Zuni Indian Hospital
• Zuni Indian Hospital Pharmacy
• Zuni Public School District
• Zuni Recovery Center

• Oxygen Equipment & Supplies (DME) in Zuni, NM
• Providers in Zuni, NM by specialty
• Oxygen Equipment & Supplies (DME) in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2012; 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.