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
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