Full Name | |
---|---|
Speciality | Local Education Agency (lea) |
Location | 7th & Elm Street, San Jon, New Mexico |
Authorized Official Name and Position | Patti Harrelson (DIRECTOR) |
Authorized Official Contact | 5755624455 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
---|---|
Po Box 847 Portales NM 88130-0847 Ph: (575) 562-4455 | 7th & Elm Street San Jon NM 88434 Ph: (575) 576-2273 |
NPI Number | 1144575044 |
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Provider Enumeration Date | 07/17/2012 |
Last Update Date | 07/17/2012 |
Identifier | Type | State | Issuer |
---|---|---|---|
1144575044 | NPI | - | NPPES |
29371571 | Medicaid | NM |