Provider Demographics
NPI:1487747150
Name:TAOS MUNICIPAL SCHOOLS
Entity type:Organization
Organization Name:TAOS MUNICIPAL SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAID LIAISON
Authorized Official - Prefix:MRS
Authorized Official - First Name:RAYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:MEDINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-758-5292
Mailing Address - Street 1:213 PASEO DEL CANON E
Mailing Address - Street 2:
Mailing Address - City:TAOS
Mailing Address - State:NM
Mailing Address - Zip Code:87571-6239
Mailing Address - Country:US
Mailing Address - Phone:505-758-5292
Mailing Address - Fax:505-758-5298
Practice Address - Street 1:213 PASEO DEL CANON E
Practice Address - Street 2:
Practice Address - City:TAOS
Practice Address - State:NM
Practice Address - Zip Code:87571-6239
Practice Address - Country:US
Practice Address - Phone:505-758-5292
Practice Address - Fax:505-758-5298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMQ1853Medicaid