Provider Demographics
NPI:1023030616
Name:JTK CORP
Entity Type:Organization
Organization Name:JTK CORP
Other - Org Name:ARTESIA MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOE
Authorized Official - Middle Name:P
Authorized Official - Last Name:SALGADO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-746-4540
Mailing Address - Street 1:PO BOX 855
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:NM
Mailing Address - Zip Code:88211-0855
Mailing Address - Country:US
Mailing Address - Phone:505-746-4540
Mailing Address - Fax:505-746-4295
Practice Address - Street 1:315 W WASHINGTON
Practice Address - Street 2:SUITE D
Practice Address - City:ARTESIA
Practice Address - State:NM
Practice Address - Zip Code:88211-0855
Practice Address - Country:US
Practice Address - Phone:505-746-4540
Practice Address - Fax:505-746-4295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-24
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM99297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMZ5574Medicaid