Healthcare Provider Details

I. General information

NPI: 1891886065
Provider Name (Legal Business Name): MESCALERO INDIAN HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

318 ABALONE LOOP
MESCALERO NM
88340-0210
US

IV. Provider business mailing address

PO BOX 210 318 ABALONE LOOP
MESCALERO NM
88340-0210
US

V. Phone/Fax

Practice location:
  • Phone: 505-464-4441
  • Fax: 505-464-3877
Mailing address:
  • Phone: 505-464-4441
  • Fax: 505-464-3877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NR1301X
TaxonomyRural Acute Care Hospital
License Number
License Number StateNM

VIII. Authorized Official

Name: MRS. DORLYNN LOUISE SIMMONS
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 505-464-4441