Organization
DHHS/IHS/AAO/JSU/DULCE HEALTH CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHARLENE HAMILTON (CHIEF EXECUTIVE OFFICER)
(575) 759-7200
Entity
Organization
Contact information
Practice address
12000 STONE LAKE ROAD, JICARILLA SERVICE UNIT, DULCE, NM 87528
(575) 759-3291
(575) 759-3532
Mailing address
P O BOX 187, 12000 STONE LAKE ROAD, DULCE, NM 87528-0187
(575) 759-3291
(575) 759-3532
Taxonomy
Speciality
Code
Description
License number
State
261QP0904X
Federal Public Health Clinic/Center
Primary
18451
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000K3526
—
NM
01
—
HSZ196
MEDICARE PART B
NM
Enumeration date
11/09/2009
Last updated
11/09/2009
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