Organization
MEDI-CONNECT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EDWARD LIDALE JONES (PRESIDENT)
(619) 254-0547
Entity
Organization
Contact information
Practice address
4140 JACKIE RD SE, RIO RANCHO, NM 87124-6624
(505) 477-4714
Mailing address
4140 JACKIE RD SE, RIO RANCHO, NM 87124-6624
(505) 477-4714
Taxonomy
Speciality
Code
Description
License number
State
163WW0000X
Wound Care Registered Nurse
—
—
207QG0300X
Geriatric Medicine (Family Medicine) Physician
—
—
251S00000X
Community/Behavioral Health Agency
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
341600000X
Ambulance
—
—
3416L0300X
Land Ambulance
Primary
—
—
343900000X
Non-emergency Medical Transport (VAN)
—
—
Other
Enumeration date
08/19/2024
Last updated
11/14/2025
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