MEDICARE: HIGH DESERT HEALTHCARE & MASSAGE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171100000X	Acupuncturist
2	225700000X	Massage Therapist

General Provider Information

NPI Number	:	1437551173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HIGH DESERT HEALTHCARE & MASSAGE, INC.

Provider Business Mailing Address
First Line	:	644 PASEO DE PERALTA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-1955
Country	:	US
Telephone Number	:	505-984-8830
Fax Number	:

Provider Business Practice Location Address
First Line	:	644 PASEO DE PERALTA
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87501-1955
Country	:	US
Telephone Number	:	505-984-8830
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	JILL GERBER
Credential	:
Telephone Number	:	505-984-8830

Provider Enumeration Date	:	09/25/2014
Last Update Date	:	09/25/2014

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