DHHS/IHS/Aao/Jsu/Dulce Health Center
Organization Active NPI Federal Public Health Clinic/Center · Dulce, NM
NPI 1548597743 · NPPES record last updated Nov 9, 2009
Key facts
- NPI
- 1548597743
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Federal Public Health Clinic/Center 261QP0904X
- License
- 18451 (CO)
- Legal business name
- DHHS/IHS/AAO/JSU/DULCE HEALTH CENTER
- Practice address
- 12000 Stone Lake Road
Jicarilla Service Unit
Dulce, NM 87528 - Phone
- (575) 759-3291
- Fax
- (575) 759-3532
- NPI assigned
- Nov 9, 2009
- Organization subpart
- No
Authorized official
- Name
- Charlene Hamilton
- Title
- Chief Executive Officer
- Phone
- (575) 759-7200
Corporate family (same tax ID) 2
Practitioners 14
-
Theresa Mary Alonzo, RT LAB TECH
-
Katherine E Berry, RDH
-
Maricela Bonilla, O.D.
-
Marie Tallent Deloach, MT(ASCP)
-
Scott Nelson, MD
-
Shari J. Fitzgerald, M.D.
-
Bichson Pham, D.O.
-
Isaac Bernard Shaw, M.D.
National Provider Directory
- Tax ID family
- Dulce Health Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Federal Public Health Clinic/Center | 261QP0904X | 18451 | CO | Yes |
Addresses
Primary practice location
12000 Stone Lake Road
Jicarilla Service Unit
Dulce, NM 87528
Mailing address
P O Box 187
12000 Stone Lake Road
Dulce, NM 87528-0187
Phone (575) 759-3291
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| HSZ196 | Other | NM | MEDICARE PART B |
| 000K3526 | Medicaid | NM |
Other providers in Dulce, NM
- Jennifer Lea Lea Claycomb
- Diana Connell
- Susan Constance
- Samuel Taylor Cropp
- Marie Tallent Deloach
- Susan Frances Donlon
- Dulce Health Center
- Dulce Independent School District
- Dulce Independent Schools
- Carrie Lynn Emens
All providers in Dulce, NM · Federal Public Health Clinic/Center 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 Nov 9, 2009. 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.