Provider Demographics
NPI:1760676480
Name:DEPARTMENT OF HEALTH - PUBLIC HEALTH DIVISION
Entity Type:Organization
Organization Name:DEPARTMENT OF HEALTH - PUBLIC HEALTH DIVISION
Other - Org Name:TUBERCULOSIS PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-841-5890
Mailing Address - Street 1:PO BOX 26110
Mailing Address - Street 2:SOUTH 1073
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-0110
Mailing Address - Country:US
Mailing Address - Phone:505-827-0664
Mailing Address - Fax:505-827-2329
Practice Address - Street 1:1190 S SAINT FRANCIS DR
Practice Address - Street 2:S1073
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4173
Practice Address - Country:US
Practice Address - Phone:505-827-0664
Practice Address - Fax:505-827-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-06
Last Update Date:2007-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare