Provider Demographics
NPI:1801081492
Name:ROSEBUD FIRE & RESCUE INC.
Entity type:Organization
Organization Name:ROSEBUD FIRE & RESCUE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EMS COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CAMPBELL
Authorized Official - Suffix:
Authorized Official - Credentials:EMT-B
Authorized Official - Phone:505-673-2326
Mailing Address - Street 1:250 BRAVO DOME HWY
Mailing Address - Street 2:
Mailing Address - City:BUEYEROS
Mailing Address - State:NM
Mailing Address - Zip Code:88415-7272
Mailing Address - Country:US
Mailing Address - Phone:505-673-2326
Mailing Address - Fax:505-673-2423
Practice Address - Street 1:1361 BRAVO DOME HIGHWAY
Practice Address - Street 2:
Practice Address - City:AMISTAD
Practice Address - State:NM
Practice Address - Zip Code:88410
Practice Address - Country:US
Practice Address - Phone:505-673-2851
Practice Address - Fax:505-673-2423
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-07
Last Update Date:2008-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM3123393416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM312339OtherNEW MEXICO
NM245740OtherPRC