Healthcare Provider Details

I. General information

NPI: 1679614598
Provider Name (Legal Business Name): INDIAN HEALTH SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

481 SANDIA LOOP PUEBLO OF SANDIA
BERNALILLO NM
87004-7076
US

IV. Provider business mailing address

5805 RIO LAMA RD NE
RIO RANCHO NM
87144-6014
US

V. Phone/Fax

Practice location:
  • Phone: 505-771-5116
  • Fax: 505-771-5107
Mailing address:
  • Phone: 505-994-4478
  • Fax: 505-771-5107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0904X
TaxonomyFederal Public Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MRS. BARBARA JEAN BENFORD-WOSKOFF
Title or Position: BUSINESS MANAGER
Credential:
Phone: 505-771-5116