Provider Demographics
NPI:1831181122
Name:CITY OF JAL GENERAL FUND
Entity type:Organization
Organization Name:CITY OF JAL GENERAL FUND
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SPECIAL PROJECTS ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:PATTI
Authorized Official - Middle Name:J
Authorized Official - Last Name:PARKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:575-395-2501
Mailing Address - Street 1:PO BOX 641880
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68164-7880
Mailing Address - Country:US
Mailing Address - Phone:402-572-4019
Mailing Address - Fax:402-991-0719
Practice Address - Street 1:309 MAIN
Practice Address - Street 2:
Practice Address - City:JAL
Practice Address - State:NM
Practice Address - Zip Code:88252-0340
Practice Address - Country:US
Practice Address - Phone:575-395-3340
Practice Address - Fax:575-395-2243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-22
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM134763416L0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3416L0300XTransportation ServicesAmbulanceLand Transport
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMR1082Medicaid
NMR1082Medicaid