Organization
PECOS VALLEY OF NEW MEXICO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER L JACKSON (SENIOR DIRECTOR, ENROLLMENT)
(877) 892-9815
Entity
Organization
Contact information
Practice address
2420 W PIERCE ST, SUITE 200 B, CARLSBAD, NM 88220-3543
(505) 628-1490
Mailing address
4000 MERIDIAN BLVD, FRANKLIN, TN 37067-6325
(615) 465-7000
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
B4739
—
NM
Enumeration date
04/20/2006
Last updated
03/17/2022
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