| Jal Clinic | |
|
805 West Kansas Avenue Jal NM 88252 | |
| (575) 395-3400 | |
| (575) 395-3355 |
| Full Name | Jal Clinic |
|---|---|
| Speciality | Clinic/Center |
| Location | 805 West Kansas Avenue, Jal, New Mexico |
| Authorized Official Name and Position | Liza Tackett (CREDENTIALING ADMINISTRATOR) |
| Authorized Official Contact | 5753953400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jal Clinic Po Box Z Jal NM 88252-2525 Ph: (575) 395-3400 | Jal Clinic 805 West Kansas Avenue Jal NM 88252 Ph: (575) 395-3400 |
| NPI Number | 1558583005 |
|---|---|
| Provider Enumeration Date | 05/03/2007 |
| Last Update Date | 03/22/2024 |
| Medicare PECOS PAC ID | 8729264478 |
|---|---|
| Medicare Enrollment ID | O20110516000264 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558583005 | NPI | - | NPPES |
| 44479 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 6179 (New Mexico) | Primary |
| Provider Name | Brandy S Gooss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1841449667 PECOS PAC ID: 8729142203 Enrollment ID: I20110516000310 |
| Provider Name | Carrie Nichole Blevins |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801172150 PECOS PAC ID: 4880996941 Enrollment ID: I20160106000819 |
| Provider Name | James Michael Gooss |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578087169 PECOS PAC ID: 4385918176 Enrollment ID: I20170918001496 |
| Provider Name | Beatrice Hauer |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1326615220 PECOS PAC ID: 8921405499 Enrollment ID: I20210927000313 |