Provider Demographics
NPI:1730101676
Name:PORTALES MEDICAL CLINIC LIMITED
Entity Type:Organization
Organization Name:PORTALES MEDICAL CLINIC LIMITED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTITIONER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:505-356-4643
Mailing Address - Street 1:320 S AVENUE A
Mailing Address - Street 2:
Mailing Address - City:PORTALES
Mailing Address - State:NM
Mailing Address - Zip Code:88130-6278
Mailing Address - Country:US
Mailing Address - Phone:505-356-4643
Mailing Address - Fax:505-359-6856
Practice Address - Street 1:320 S AVENUE A
Practice Address - Street 2:
Practice Address - City:PORTALES
Practice Address - State:NM
Practice Address - Zip Code:88130-6278
Practice Address - Country:US
Practice Address - Phone:505-356-4643
Practice Address - Fax:505-359-6856
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care