MEDICARE: JACK D VICK MD

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	207Q00000X	Family Medicine Physician	92371	NM

General Provider Information

NPI Number	:	1538242219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACK D VICK MD

Provider Business Mailing Address
First Line	:	PO BOX 349
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

Provider Business Practice Location Address
First Line	:	546 N. 10TH STREET
Second Line	:
City	:	FORT SUMNER
State	:	NM
Zip	:	88119-0349
Country	:	US
Telephone Number	:	575-355-2414
Fax Number	:	575-355-7894

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/24/2006
Last Update Date	:	05/19/2009

Similar Medicare Providers

1306832019 — CAROLYN KAY CARAWAY FNP
Practice Location Address:

546 N. 10TH ST.
FORT SUMNER, NM
88119-0349

Practice Phone: 575-355-2414
Practice Fax: 575-355-7894

1225183908 — KEVIN ALAN MARTINEZ LISW
Practice Location Address:

546 N 10TH STREET
FORT SUMNER, NM
88119-0349

Practice Phone: 575-355-2420
Practice Fax: 575-355-7894

1356656466 — MS. MICHELLE ANTOINETTE BRUCE LMSW
Practice Location Address:

546 N. 10TH ST
FORT SUMNER, NM
88119-0349

Practice Phone: 575-355-2414
Practice Fax: 575-355-7894

1699082644 — DE BACA FAMILY PRACTICE CLINIC
Practice Location Address:

1001 SUMNER AVE
FORT SUMNER, NM
88119-0349

Practice Phone: 575-355-4431
Practice Fax: 575-355-4432

1770133746 — CANDACE M KERNELL CFNP
Practice Location Address:

546 N. 10TH STREET
FORT SUMNER, NM
88119-0349

Practice Phone: 575-355-2414
Practice Fax: 575-355-7894

1023001591 — MRS. DARLENE G JENKINS CFNP
Practice Location Address:

546 NORTH 10TH ST.
FORT SUMNER, NM
88119

Practice Phone: 575-355-2444
Practice Fax: 575-253-4214

Directions to “ JACK D VICK MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2025 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.