NPI
Jicarilla Apache Nation
This page is a copy of the public NPPES file.
Facts
- Status
- Active
- Type
- Organization
- Enumeration date
- 2013-09-19
- Last updated
- 2015-05-20
Specialties
Licenses
The registry row did not include a license.
Location
- Practice location
- 450 N Mundo Dr.
- City
- Dulce NM
- Postal code
- 87528
- Phone
- (575) 759-4206
Organization contact
- Name
- TY VICENTI
- Title
- President
- Phone
- 5757594201
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
No exclusion found for this NPI in the OIG LEIE file dated October 9, 2026. OIG's online search is the official check.
Nearby
Other NPIs in Dulce, NM. 76 records in the public file.
Removal request
Public data from NPPES and CMS. Not a credentialing determination.
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