1538231600 NPI number — PATRICIA RUFFIER

Table of content: (NPI 1538231600)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538231600 NPI number — PATRICIA RUFFIER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA RUFFIER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
1ST MEDICAL SUPPLY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538231600
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
151 S WALNUT ST
Provider Second Line Business Mailing Address:
STE C-9
Provider Business Mailing Address City Name:
LAS CRUCES
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88001-2605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-522-2011
Provider Business Mailing Address Fax Number:
505-522-2331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
151 S WALNUT ST
Provider Second Line Business Practice Location Address:
STE C-9
Provider Business Practice Location Address City Name:
LAS CRUCES
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88001-2605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-522-2011
Provider Business Practice Location Address Fax Number:
505-522-2331
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RUFFIER
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
505-522-2011

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  9358 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: NM00TB59 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 185107302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 72102772 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185107301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: QMP000003404554 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com