Healthcare Provider Details

I. General information

NPI: 1326217043
Provider Name (Legal Business Name): DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/12/2025
Certification Date: 02/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 MARK AVE
GALLUP NM
87301-4822
US

IV. Provider business mailing address

PO BOX 1337
GALLUP NM
87305-1337
US

V. Phone/Fax

Practice location:
  • Phone: 505-722-1000
  • Fax: 505-722-1310
Mailing address:
  • Phone: 505-722-1000
  • Fax: 505-722-1310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number9435
License Number State

VIII. Authorized Official

Name: PAMELA DETSOI-SMILEY
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: CEO
Phone: 505-722-1000