MEDICARE: TRIPLE J FABRICATION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171W00000X	Contractor

General Provider Information

NPI Number	:	1144184227
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TRIPLE J FABRICATION LLC

Provider Business Mailing Address
First Line	:	PO BOX 503
Second Line	:
City	:	FAIRACRES
State	:	NM
Zip	:	88033-0503
Country	:	US
Telephone Number	:	575-650-9614
Fax Number	:

Provider Business Practice Location Address
First Line	:	3200 OLD PICACHO ROAD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88007
Country	:	US
Telephone Number	:	575-650-9614
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	BRIANNA LUCERO
Credential	:
Telephone Number	:	575-650-9614

Provider Enumeration Date	:	12/12/2025
Last Update Date	:	12/12/2025

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