Active NPI
Indian Health Service- Jicarilla Service Unit
- Clinical Medical Laboratory
- Dulce, NM
National Provider Identifier
1477628659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Medical Laboratory
- Legal business name
- INDIAN HEALTH SERVICE- JICARILLA SERVICE UNIT
- Practice address
- 12000 Stone Lake Drive
Dulce, NM 87528-0187 - Phone
- (505) 759-3291
- NPI assigned
- Nov 22, 2006
- Last updated
- Aug 22, 2020
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Mr. Jim Sutton
- Title
- Ceo
- Phone
- (505) 759-3291
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Medical Laboratory | 291U00000X | Primary |
Addresses
Primary practice location
12000 Stone Lake Drive
Dulce, NM 87528-0187
Mailing address
PO Box 804
Dulce, NM 87528-0804
Phone (505) 759-0440
National Provider Directory
National Provider Directory- Tax ID family
- Dulce Health Center
Other organizations with this tax ID 2
Organizations that report the same tax identification number in the National Provider Directory.
-
- Federal Public Health Clinic/Center
- Dulce, NM
- NPI 1548597743
-
dba Dulce IHS Pharmacy
- Indian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
- Dulce, NM
- NPI 1124220900
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164153600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1598054400000",
"number": "1477628659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 804",
"city": "DULCE",
"state": "NM",
"postal_code": "875280804",
"telephone_number": "505-759-0440"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12000 STONE LAKE DRIVE",
"city": "DULCE",
"state": "NM",
"postal_code": "875280187",
"telephone_number": "505-759-3291"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "INDIAN HEALTH SERVICE- JICARILLA SERVICE UNIT",
"organizational_subpart": "NO",
"enumeration_date": "2006-11-22",
"last_updated": "2020-08-22",
"status": "A",
"authorized_official_last_name": "SUTTON",
"authorized_official_first_name": "JIM",
"authorized_official_title_or_position": "CEO",
"authorized_official_telephone_number": "505-759-3291",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "291U00000X",
"taxonomy_group": "",
"desc": "Clinical Medical Laboratory",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dulce, NM
- Sharon Hope Greacen, MT(ASCP)
- Steven Paul Gross, M.D.
- Daniel Xethan Haire, DO
- Patrick S Hogan, RPH
- Diane P Holzem, RN,C
- Deanna S Iovine, RN
- Jicarilla Apache Health Care Facility
- Jicarilla Apache Nation (Jicarilla Behavioral Health)
- Jicarilla Apache Nation (Jicarilla Apache Nation Dialysis Treatment Center)
- Jicarilla EMS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.