Provider Demographics
NPI:1700992617
Name:THOREAU AMBULANCE SERVICE
Entity type:Organization
Organization Name:THOREAU AMBULANCE SERVICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS CHIEF
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HOFFMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-862-7482
Mailing Address - Street 1:PO BOX 1115
Mailing Address - Street 2:
Mailing Address - City:THOREAU
Mailing Address - State:NM
Mailing Address - Zip Code:87323-1115
Mailing Address - Country:US
Mailing Address - Phone:505-862-7482
Mailing Address - Fax:
Practice Address - Street 1:#65 FIRST ST
Practice Address - Street 2:
Practice Address - City:THOREAU
Practice Address - State:NM
Practice Address - Zip Code:87323
Practice Address - Country:US
Practice Address - Phone:505-862-7482
Practice Address - Fax:505-863-7486
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COUNTY OF MCKINLEY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-22
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM19999341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM590012242OtherRAILROAD MEDICARE
NM000R4623Medicaid
NM000R4623Medicaid