1245409960 NPI number — DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245409960 NPI number — DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
RED ROCK CARE CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245409960
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1337
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GALLUP
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87305-1337
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-722-1000
Provider Business Mailing Address Fax Number:
505-722-1310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3720 CHURCH ROCK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GALLUP
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87301-4572
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-722-1000
Provider Business Practice Location Address Fax Number:
505-722-1310
Provider Enumeration Date:
02/27/2008

Additional Information

Authorized Official

Authorized Official Last Name:
YAZZIE
Authorized Official First Name:
BENNIE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
505-722-1402

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  9435 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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