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Contact Information

JACQUE NEWMAN, CO
221 STATE HIGHWAY 165 STE F
PLACITAS, NM87043-9514
 Phone: 505-353-2484
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Prosthetic/Orthotic Supplier

335E00000X 51 Medical Supply Company with Orthotist
 

Mastectomy Fitter

224900000X
 

Orthotist

222Z00000X 55 Individual Certified Orthotist
 

Prosthetist

224P00000X 56 Individual Certified Prosthetist
Indicates primary specialty

NPI Profile & details for

NPI # 1982292561
Entity Organization
Organization subpart 1 Not specified
Enumeration date 01/08/2021
Last updated 04/24/2025 - More than a year ago
Identifiers
NM Medicaid 06551769
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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