Mr Vernon Thomas Jaques, LCSW | |
516 E. Nizhoni Blvd, Gallup, NM 87301-5748 | |
(505) 722-1000 | |
(928) 697-4189 |
Full Name | Mr Vernon Thomas Jaques |
---|---|
Gender | Male |
Speciality | Clinical Social Worker |
Experience | 29 Years |
Location | 516 E. Nizhoni Blvd, Gallup, New Mexico |
Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
Identifier | Type | State | Issuer |
---|---|---|---|
1689746554 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
1041C0700X | Social Worker - Clinical | C-10278 (New Mexico) | Primary |
1041C0700X | Social Worker - Clinical | M-04628 (New Mexico) | Secondary |
Facility Name | Location | Facility Type |
---|---|---|
Gallup Indian Medical Center | Gallup, NM | Hospital |
Group Practice Name | Group PECOS PAC ID | No. of Members |
---|---|---|
Dhhs,phs,naihs, Gallup Indian Medical Center | 3173436409 | 121 |
Entity Name | Dhhs,phs,naihs, Gallup Indian Medical Center |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1225002322 PECOS PAC ID: 3173436409 Enrollment ID: O20031111000840 |
Entity Name | Kayenta Alternative Rural Hospital |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1174692529 PECOS PAC ID: 3678558129 Enrollment ID: O20040621000422 |
Mailing Address | Practice Location Address |
---|---|
Mr Vernon Thomas Jaques, LCSW Po Box 1337, Gallup, NM 87305-1337 Ph: (505) 722-1000 | Mr Vernon Thomas Jaques, LCSW 516 E. Nizhoni Blvd, Gallup, NM 87301-5748 Ph: (505) 722-1000 |
Summer B Hogue, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 516 E Nizhoni Blvd, Gallup, NM 87301 Phone: 505-722-1000 | |
Betty Sharon Spencer, LCSW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 516 E Nizhoni Blvd, Gallup, NM 87301 Phone: 505-722-1000 Fax: 928-697-4189 | |
Tristan Glenn Keller, LISW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 2025 E Aztec Ave, Gallup, NM 87301 Phone: 505-863-3828 Fax: 505-863-6612 | |
Judy Martinez, Clinical Social Worker Medicare: Accepting Medicare Assignments Practice Location: 516 E Nizhoni Blvd, Gallup, NM 87301 Phone: 505-722-1000 | |
Sierra Rose Yazzie Asamoa-tutu, LCSW Clinical Social Worker Medicare: Medicare Enrolled Practice Location: 2025 E Aztec Ave, Gallup, NM 87301 Phone: 505-863-3120 | |
Beverly Tamanini, LISW Clinical Social Worker Medicare: Not Enrolled in Medicare Practice Location: 208 1/2 E Hill Ave, Gallup, NM 87301 Phone: 505-863-1930 |