Healthcare Provider Details

I. General information

NPI: 1033943261
Provider Name (Legal Business Name): CITY OF GALLUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2024
Last Update Date: 08/29/2024
Certification Date: 08/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 W LINCOLN AVE
GALLUP NM
87301-5075
US

IV. Provider business mailing address

PO BOX 18230
GALLUP NM
81300-0230
US

V. Phone/Fax

Practice location:
  • Phone: 505-863-1383
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3416L0300X
TaxonomyLand Ambulance
License Number
License Number State

VIII. Authorized Official

Name: JESSICA CREECH
Title or Position: EMS COORDINATOR
Credential:
Phone: 505-863-1383