JICARILLA HEALTH CARE FACILITY (NPI# 1003820069) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1003820069 |
| Entity Type | Organization |
| Organization Name | JICARILLA HEALTH CARE FACILITY |
| Practice Address |
12000 Stone Lake Rd Dulce NM 87528 |
| Mailing Address |
Po Box 1144 Pagosa Springs CO 81147-1144 |
| Practice Telephone | 5057597286 |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. THOMAS T PRYOR (PUBLIC HEALTH NURSE) |
| Authorized Official Telephone | 5057597286 |
| Authorized Official Credential | RN |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QC1500X |
Clinic/Center Specialization: Community Health |
OR | Ambulatory Health Care Facilities |
| Street Address |
12000 STONE LAKE RD |
| City | DULCE |
| State | NM |
| Zip Code | 87528 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508832791 | Kristine S Williams | Dietitian, Registered | 12000 Stone Lake Rd, Dulce Health Center, Dulce, NM 87528 | 2006-02-27 |
| 1710210455 | Carolyn Lieb | Pharmacy Technician | 12000 Stone Lake Rd, Dulce, NM 87528-0187 | 2009-09-14 |
| 1124220900 | Jicarilla Ihs Pharmacy | Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy | 12000 Stone Lake Rd, Dulce, NM 87528 | 2007-06-04 |
| 1598985798 | John E Shumack | Pharmacist | 12000 Stone Lake Rd, Dulce, NM 87528 | 2007-04-27 |
| 1922178359 | Robert Patrick Sewell | Dentist | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-11-09 |
| 1346326600 | Jicarilla Apache Health Care Facility | Clinic/Center | 12000 Stone Lake Rd, Dulce, NM 87528-0187 | 2006-10-30 |
| 1427160282 | Susan Frances Donlon | Registered Nurse | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-08-31 |
| 1194834242 | Katherine E Berry | Dental Hygienist | 12000 Stone Lake Rd, Jicarilla Apache Health Care Facility, Ihs, Dulce, NM 87528-0000 | 2006-08-30 |
| 1255347043 | Gaylia Dianne Pride | Registered Nurse | 12000 Stone Lake Rd, Dulce, NM 87528 | 2006-07-31 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164917373 | Kelly Rae Pettigrew | Optometrist | 505 North Mundo, Dulce, NM 87528 | 2018-06-29 |
| 1780003442 | Jacob Alexander | Preventive Medicine | 500 N. Mundo, Dulce, NM 87528 | 2014-04-09 |
| 1881020089 | Jicarilla Apache Nation | Clinic/Center | 450 N Mundo Dr., Dulce, NM 87528 | 2013-09-19 |
| 1285971515 | Samuel Taylor Cropp | Pharmacist | 500 N Mundo Dr, Dulce, NM 87528 | 2013-01-07 |
| 1720331697 | Northwest Reional Education Coop #2 | Student in an Organized Health Care Education/Training Program | 91 Hawk Drive, Dulce, NM 87528 | 2012-10-17 |
| 1306116066 | Michael Shawn Kennedy | Psychologist | 113 Hawk Dr, Dulce, NM 87528 | 2012-01-11 |
| 1669762043 | Veronica A Medlin | Technician, Pathology | 1200 Stone Lake Rd, Dulce, NM 87528 | 2011-04-19 |
| 1891085262 | Stella Elizabeth Wilson | Spec/Tech, Pathology | 500 Stone Lake Road, Dulce, NM 87528 | 2011-04-19 |
| 1134419518 | Ray Morris Joe | Technician, Pathology | 500 North Mundo Road, Dulce, NM 87528 | 2011-04-19 |
| 1801186341 | Raquel Irene Cisneros | Family Medicine | 500 N. Mundo Dr., Dulce, NM 87528 | 2011-04-18 |
| Find all providers in zip 87528 | ||||
| Taxonomy Code | 261QC1500X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Community Health |
| Definition to come... |
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| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.