Marie Tallent Deloach, MT(ASCP)
Individual provider Active NPI Medical Technologist · Dulce, NM
NPI 1508138660 · NPPES record last updated Feb 6, 2012
Key facts
- NPI
- 1508138660
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Medical Technologist 246QM0706X
- License
- 03671395 (SC)
- Practice address
- 500 North Mundo
Dulce, NM 87528 - Phone
- (575) 759-7252
- Fax
- (575) 759-3532
- NPI assigned
- Feb 6, 2012
- Sex
- Female
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 03671395 | SC | MD | Medical Technologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dulce Health Center | Past |
Accepting new patients | |
| Jicarilla IHS Pharmacy | Past |
Accepting new patients | |
| DHHS/IHS/Aao/Jsu/Dulce Health Center | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Medical Technologist | 246QM0706X | 03671395 | SC | Yes |
Addresses
Primary practice location
500 North Mundo
Dulce, NM 87528
Mailing address
PO Box 187
500 North Mundo
Dulce, NM 87528-0187
Phone (575) 759-7252
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| 000K3526 | Medicaid | NM |
Other providers in Dulce, NM
- Raquel Irene Cisneros
- Jennifer Lea Lea Claycomb
- Diana Connell
- Susan Constance
- Samuel Taylor Cropp
- DHHS/IHS/Aao/Jsu/Dulce Health Center
- Susan Frances Donlon
- Dulce Health Center
- Dulce Independent School District
- Dulce Independent Schools
All providers in Dulce, NM · Medical Technologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.