Provider Demographics
NPI:1275712069
Name:TULAROSA CLINIC INC.
Entity Type:Organization
Organization Name:TULAROSA CLINIC INC.
Other - Org Name:JAGDEV I SINGH
Other - Org Type:Other Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:
Authorized Official - Last Name:SINGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-437-1900
Mailing Address - Street 1:1909 CUBA AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-5646
Mailing Address - Country:US
Mailing Address - Phone:575-437-1900
Mailing Address - Fax:575-437-3322
Practice Address - Street 1:1909 CUBA AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-5646
Practice Address - Country:US
Practice Address - Phone:575-437-1900
Practice Address - Fax:575-437-3322
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2011-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM00025908Medicaid
NM002584OtherBLUE CROSS BLUE SHIELD
NM2121149Medicare PIN