Provider Demographics
NPI:1447264874
Name:DONA ANA MEDICAL SUPPLY
Entity type:Organization
Organization Name:DONA ANA MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/MANAGER/REG. RESP. THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ABRAHAM
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:RRT
Authorized Official - Phone:575-644-2701
Mailing Address - Street 1:3851 E LOHMAN AVE
Mailing Address - Street 2:SUITE #4
Mailing Address - City:LAS CRUCES
Mailing Address - State:NM
Mailing Address - Zip Code:88011-8296
Mailing Address - Country:US
Mailing Address - Phone:575-522-5931
Mailing Address - Fax:575-522-4532
Practice Address - Street 1:3851 E LOHMAN AVE
Practice Address - Street 2:SUITE #4
Practice Address - City:LAS CRUCES
Practice Address - State:NM
Practice Address - Zip Code:88011-8296
Practice Address - Country:US
Practice Address - Phone:575-522-5931
Practice Address - Fax:575-522-4532
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-28
Last Update Date:2013-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM02946075001332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM65801571Medicaid
NM=========OtherTAX ID NUMBER
NM4805110001Medicare NSC