Organization
SAN JON SCHOOL BASED HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GARY SALAZAR (SUPERINTENDENT OF SCHOOLS)
(575) 576-2467
Entity
Organization
Contact information
Practice address
7TH AND ELM STREET, SAN JON, NM 88434
(575) 576-2273
(575) 576-2273
Mailing address
PO BOX 5, SAN JON, NM 88434-0005
(575) 576-2273
(575) 576-2273
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1E03
—
NM
Enumeration date
12/14/2010
Last updated
12/14/2010
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