Organization
JAL HOSPITAL DISTRICT
Active
Organization
JAL HOSPITAL DISTRICT
Active
Other names
JAL CLINIC
Organization subpart
No
Provider details
NPI number
Authorized official
LIZA TACKETT (CREDENTIALING ADMINISTRATOR)
(575) 395-3400
Entity
Organization
Contact information
Practice address
805 WEST KANSAS AVENUE, JAL, NM 88252
(575) 395-3400
(575) 395-3355
Mailing address
PO BOX Z, JAL, NM 88252-2525
(575) 395-3400
(575) 395-3355
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
—
—
225100000X
Physical Therapist
—
—
261Q00000X
Clinic/Center
Primary
6179
NM
363LF0000X
Family Nurse Practitioner
—
—
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
44479
—
NM
Enumeration date
05/03/2007
Last updated
07/24/2024
Update your record
If you believe information in your NPPES record is inaccurate, or if you wish to update or deactivate your NPI, you can do so directly with CMS at https://nppes.cms.hhs.gov.
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Sign up