=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861412777
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALAMO NAVAJO SCHOOL BOARD, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/20/2006
-----------------------------------------------------
Last Update Date | 03/07/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | MILEPOST 29, HIGHWAY 169
-----------------------------------------------------
City | ALAMO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-854-2626
-----------------------------------------------------
Fax | 575-854-2528
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 5907
-----------------------------------------------------
City | ALAMO
-----------------------------------------------------
State | NM
-----------------------------------------------------
Zip | 87825
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 575-854-2626
-----------------------------------------------------
Fax | 575-854-2528
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | HEALTH SERVICES DIRE
-----------------------------------------------------
Name | MS. CLORA PHYLLIS COLLINS
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 575-854-2626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | J6136
-----------------------------------------------------
License Number State | NM
-----------------------------------------------------