904 West Main LLC
NPI #1003517228 in Farmington, New Mexico
Provider Information
- NPI Number
- 1003517228
- Entity Type
- Organization
- Organization Name
- 904 West Main LLC
- Primary Specialty
- Non-emergency Medical Transport (VAN)
- Enumeration Date
- Mar 14, 2023
- Last Updated
- Sep 2, 2024
Practice Location
- Address
- 130 AIRPORT DR STE B
- City
- Farmington
- State
- New Mexico
- ZIP Code
- 87401-5520
- Phone
- (505) 793-6750
Authorized Official
- Name
- KURT COOK
- Title
- OWNER
- Phone
- (505) 793-6750
Specialties & Taxonomy Codes
| Specialty |
|---|
| Non-emergency Medical Transport (VAN) |
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