Provider Demographics
NPI:1063579506
Name:COUNTY OF SANDOVAL
Entity type:Organization
Organization Name:COUNTY OF SANDOVAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FIRE CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:
Authorized Official - Last Name:MASTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-867-0245
Mailing Address - Street 1:PO BOX 40
Mailing Address - Street 2:
Mailing Address - City:BERNALILLO
Mailing Address - State:NM
Mailing Address - Zip Code:87004-0040
Mailing Address - Country:US
Mailing Address - Phone:505-867-0245
Mailing Address - Fax:505-867-6256
Practice Address - Street 1:301 PIEDRA LISA ST
Practice Address - Street 2:
Practice Address - City:BERNALILLO
Practice Address - State:NM
Practice Address - Zip Code:87004-5809
Practice Address - Country:US
Practice Address - Phone:505-867-0245
Practice Address - Fax:505-857-6256
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00R066OtherBCBS
NMH3754Medicaid
NM=========Medicare PIN