Provider Demographics
NPI:1285887687
Name:ELIDA FIRE DEPARTMENT
Entity type:Organization
Organization Name:ELIDA FIRE DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF
Authorized Official - Prefix:MR
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANTHONY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-274-6465
Mailing Address - Street 1:704 CLARK STREET
Mailing Address - Street 2:P.O. BOX 208
Mailing Address - City:ELIDA
Mailing Address - State:NM
Mailing Address - Zip Code:88116-0208
Mailing Address - Country:US
Mailing Address - Phone:575-274-6465
Mailing Address - Fax:
Practice Address - Street 1:405 US 70
Practice Address - Street 2:
Practice Address - City:ELIDA
Practice Address - State:NM
Practice Address - Zip Code:88116-0208
Practice Address - Country:US
Practice Address - Phone:575-274-6465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-29
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM03233603416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========Medicare PIN