904 West Main LLC
NPI #1235964172 in Farmington, New Mexico
Provider Information
- NPI Number
- 1235964172
- Entity Type
- Organization
- Organization Name
- 904 West Main LLC
- Primary Specialty
- Durable Medical Equipment & Medical Supplies
- Enumeration Date
- Sep 2, 2024
- Last Updated
- Sep 2, 2024
Practice Location
- Address
- 615 W BROADWAY
- City
- Farmington
- State
- New Mexico
- ZIP Code
- 87401-5910
- Phone
- (505) 535-4196
Authorized Official
- Name
- KURT COOK
- Title
- CEO
- Phone
- (505) 793-6750
Specialties & Taxonomy Codes
| Specialty |
|---|
| Durable Medical Equipment & Medical Supplies |
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