Organization
JICARILLA HEALTH CARE FACILITY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. THOMAS T PRYOR RN (PUBLIC HEALTH NURSE)
(505) 759-7286
Entity
Organization
Contact information
Practice address
12000 STONE LAKE RD, DULCE, NM 87528
(505) 759-7286
Mailing address
PO BOX 1144, PAGOSA SPRINGS, CO 81147-1144
Taxonomy
Speciality
Code
Description
License number
State
261QC1500X
Community Health Clinic/Center
Primary
—
OR
Other
Enumeration date
07/27/2006
Last updated
08/22/2020
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