Organization
PUEBLO OF JEMEZ
Active
Organization subpart
No
Provider details
NPI number
Authorized official
NOHEMY ROSALES (BUSINESS OFFICE MANAGER)
(575) 834-3187
Entity
Organization
Contact information
Practice address
110 SHEEP SPRINGS WAY, JEMEZ PUEBLO, NM 87024
(575) 834-7413
(575) 834-7517
Mailing address
PO BOX 279, JEMEZ PUEBLO, NM 87024-0279
(575) 834-7413
(575) 834-7517
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
NA
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3209308
NCPDP CLINIC PHARMACY
NM
05
—
65337239
—
NM
01
—
79737
MEDICAID CLINIC PHARMACY
NM
Enumeration date
02/22/2007
Last updated
02/11/2022
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