Provider Demographics
NPI:1336155126
Name:CITY OF PORTALES
Entity type:Organization
Organization Name:CITY OF PORTALES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CITY CLERK
Authorized Official - Prefix:
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SWOPES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-356-3158
Mailing Address - Street 1:1028 COMMUNITY WAY
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130
Mailing Address - Country:US
Mailing Address - Phone:575-356-6662
Mailing Address - Fax:575-563-3158
Practice Address - Street 1:301 S AVE C
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130
Practice Address - Country:US
Practice Address - Phone:575-356-4406
Practice Address - Fax:575-359-0925
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF PORTALES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-31
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
341600000X, 3416L0300X
NM124343416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM=========OtherAMBULANCE
NMR1272Medicaid
NM=========OtherAMBULANCE