JICARILLA APACHE NATION (NPI# 1881020089) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1881020089 |
| Entity Type | Organization |
| Organization Name | JICARILLA APACHE NATION |
| Other Organization Name | JICARILLA APACHE NATION DIALYSIS TREATMENT CENTER |
| Practice Address |
450 N Mundo Dr. Dulce NM 87528 |
| Practice Telephone | 5757594206 |
| Practice Fax Number | 5757594471 |
| Mailing Telephone | 5757594206 |
| Mailing Fax Number | 5757594471 |
| Enumeration Date | 2013-09-19 |
| Last Update Date | 2015-05-20 |
| Authorized Official Name | TY VICENTI (PRESIDENT) |
| Authorized Official Telephone | 5757594201 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 261QE0700X |
Clinic/Center Specialization: End-Stage Renal Disease (ESRD) Treatment |
Ambulatory Health Care Facilities |
| Other Name | Type Code |
|---|---|
| Jicarilla Apache Nation Dialysis Treatment Center | Doing Business As Name - Organization |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1508051061 | Jicarilla Apache Nation | Community/Behavioral Health | 109 Seneca Drive, Dulce, NM 87528 | 2007-09-07 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| System for Award Management (SAM) Entities | JICARILLA APACHE NATION | 25 Hawks Dr, Dulce, NM 87528 |
| System for Award Management (SAM) Entities | JICARILLA APACHE NATION POWER AUTHORITY | 50 North Mundo Dr, Dulce, NM 87528 |
| Street Address |
450 N MUNDO DR. |
| City | DULCE |
| State | NM |
| Zip Code | 87528 |
| 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 |
| 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 |
| 1285823435 | Karen Keating | Counselor | 26 Narrow Gauge Dr., Dulce, NM 87528 | 2007-10-23 |
| Find all providers in zip 87528 | ||||
| Taxonomy Code | 261QE0700X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | End-Stage Renal Disease (ESRD) Treatment |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1447866108 | Bio-medical Applications of New Mexico, Inc. | Clinic/Center | 2050 Knudsen Ave, Ste C, Farmington, NM 87401-9070 | 2020-09-18 |
| 1306499405 | Trc Four Corners Dialysis Clinics LLC | Clinic/Center | 4525 Rowe Ave, Farmington, NM 87402-3013 | 2019-07-18 |
| 1457829269 | Valley Home Dialysis | Clinic/Center | 3900 E Lohman Ave Ste B1, Las Cruces, NM 88011-8268 | 2018-11-09 |
| 1235636283 | Usrc Las Cruces LLC | Clinic/Center | 250 E Amador Ave, Las Cruces, NM 88001-3649 | 2018-04-06 |
| 1124523857 | Bio Medical Applications of New Mexico, Inc. | Clinic/Center | 5221 Las Soleras Dr, Santa Fe, NM 87507-2101 | 2018-03-26 |
| 1710406301 | Dialysis Clinic Inc | Clinic/Center | 8121 Central Ave Nw, Albuquerque, NM 87121-2125 | 2017-09-14 |
| 1033634175 | Chantry Dialysis, LLC | Clinic/Center | 10410 Copper Point Way Ne, Albuquerque, NM 87123-1158 | 2017-08-10 |
| 1124477112 | Home Dialysis of Santa Fe, LLC | Clinic/Center | 2904 Rodeo Park Dr E Ste 300a-1, Santa Fe, NM 87505-6305 | 2016-06-09 |
| 1811358609 | Solid Rock Dialysis, LLC | Clinic/Center | 1580 Highway 264, Suite A, Gallup, NM 87301-3302 | 2016-03-08 |
| 1003274309 | Fresenius Medical Care Sandhill, LLC | Clinic/Center | 1306 Enterprise Rd., Socorro, NM 87801 | 2016-02-02 |
| 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.