INDIAN HEALTH SERVICE- JICARILLA SERVICE UNIT (NPI# 1477628659) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1477628659 |
| Entity Type | Organization |
| Organization Name | INDIAN HEALTH SERVICE- JICARILLA SERVICE UNIT |
| Practice Address |
12000 Stone Lake Drive Dulce NM 87528-0187 |
| Mailing Address |
Po Box 804 Dulce NM 87528-0804 |
| Practice Telephone | 5057593291 |
| Mailing Telephone | 5057590440 |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2020-08-22 |
| Authorized Official Name | MR. JIM SUTTON (CEO) |
| Authorized Official Telephone | 5057593291 |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | Laboratories |
| Street Address |
12000 STONE LAKE DRIVE |
| City | DULCE |
| State | NM |
| Zip Code | 87528-0187 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1194747279 | Sharon Hope Greacen | Spec/Tech, Pathology | 12000 Stone Lake Drive, Laboratory, Dulce, NM 87528-0187 | 2006-07-24 |
| 1376685545 | Susan Ann Velarde | Specialist/Technologist, Other | 12000 Stone Lake Drive, Dulce, NM 87528 | 2007-02-13 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164917373 | Kelly Rae Pettigrew | Optometrist | 505 North Mundo, Dulce, NM 87528 | 2018-06-29 |
| 1780003442 | Jacob Alexander | Preventive Medicine | 500 N. Mundo, Dulce, NM 87528 | 2014-04-09 |
| 1881020089 | Jicarilla Apache Nation | Clinic/Center | 450 N Mundo Dr., Dulce, NM 87528 | 2013-09-19 |
| 1285971515 | Samuel Taylor Cropp | Pharmacist | 500 N Mundo Dr, Dulce, NM 87528 | 2013-01-07 |
| 1720331697 | Northwest Reional Education Coop #2 | Student in an Organized Health Care Education/Training Program | 91 Hawk Drive, Dulce, NM 87528 | 2012-10-17 |
| 1306116066 | Michael Shawn Kennedy | Psychologist | 113 Hawk Dr, Dulce, NM 87528 | 2012-01-11 |
| 1669762043 | Veronica A Medlin | Technician, Pathology | 1200 Stone Lake Rd, Dulce, NM 87528 | 2011-04-19 |
| 1891085262 | Stella Elizabeth Wilson | Spec/Tech, Pathology | 500 Stone Lake Road, Dulce, NM 87528 | 2011-04-19 |
| 1134419518 | Ray Morris Joe | Technician, Pathology | 500 North Mundo Road, Dulce, NM 87528 | 2011-04-19 |
| 1801186341 | Raquel Irene Cisneros | Family Medicine | 500 N. Mundo Dr., Dulce, NM 87528 | 2011-04-18 |
| Find all providers in zip 87528 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1730262783 | Theresa Mary Alonzo | Clinical Medical Laboratory | 12000 Stone Lake Road, Dulce, NM 87528-0187 | 2006-10-23 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
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| 1407411762 | Ron Smock | Clinical Medical Laboratory | 4213 Montgomery Blvd Ne, Albuquerque, NM 87109-1103 | 2019-05-02 |
| 1780059717 | Southwest Labs LLC | Clinical Medical Laboratory | 4261 Balloon Park Rd Ne, Albuquerque, NM 87109-5802 | 2015-12-02 |
| 1669858700 | Nex Step, Inc. | Clinical Medical Laboratory | 518 Old Santa Fe Trl, Suite 1, Pmb 220, Santa Fe, NM 87505-0398 | 2015-07-30 |
| 1225424567 | Recovery Services of New Mexico | Clinical Medical Laboratory | 5659 Jefferson St Ne, Suite E, Albuquerque, NM 87109-3458 | 2015-04-14 |
| 1255725339 | Ann Owens Tafoya | Clinical Medical Laboratory | 1301 Kentucky St Se, Albuquerque, NM 87108-5108 | 2015-03-26 |
| 1740615855 | Elizabeth Amanda Stenger | Clinical Medical Laboratory | 10444 Calle Avila Nw, Albuquerque, NM 87114-1804 | 2013-09-08 |
| 1821381773 | Alethea Laboratories Inc | Clinical Medical Laboratory | 410 E. Foster Road, Las Cruces, NM 88005-3209 | 2011-05-25 |
| 1083946222 | Metwest Inc | Clinical Medical Laboratory | 1121 Mall Dr, Las Cruces, NM 88011-8102 | 2010-02-12 |
| 1467783753 | Matrix Genomics, Inc. | Clinical Medical Laboratory | 3900 Paseo Del Sol, Santa Fe, NM 87507-4072 | 2010-01-26 |
| Find all providers with the same taxonomy | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.