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General NPI Number Information
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NPI Number | 1477684447
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Entity Type | Organization
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Legal Business Name | JICARILLA EMS
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Dates
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Enumeration Date | 03/08/2007
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Last Update Date | 02/21/2013
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Provider Practice Location Address
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Address Line | 2300 NARROW GAUGE RD
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City | DULCE
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State | NM
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Zip | 87528
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Country | US
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Telephone | 575-759-3778
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Fax | 575-759-3841
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Provider Business Mailing Address
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Address Line | POB 769 2300 NARROW GAUGE RD
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City | DULCE
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State | NM
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Zip | 87528
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Country | US
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Telephone | 575-759-3778
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Fax | 575-759-3841
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Authorized Official
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Title or Position | ACTING DIRECTOR
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Name | MRS. DAWN BURNS
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Credential |
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Telephone | 575-759-3778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3416L0300X
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Taxonomy Name | Land Ambulance
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License Number | 47495
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License Number State | NM
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