Organization
PECOS VALLEY OF NEW MEXICO LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SR. DIRECTOR PROVIDER ENROLLMENT)
(615) 465-3334
Entity
Organization
Contact information
Practice address
2402 W PIERCE ST, SUITE 6E, CARLSBAD, NM 88220-3537
(575) 628-5066
(575) 628-0493
Mailing address
PO BOX 689022, FRANKLIN, TN 37068-9022
(615) 465-7354
(615) 628-6877
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B4739
—
NM
Enumeration date
04/07/2009
Last updated
05/10/2021
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