Healthcare Provider Details

I. General information

NPI: 1528074390
Provider Name (Legal Business Name): HIGH PLAINS MEDICAL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 05/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1108 W US ROUTE 66
MORIARTY NM
87035-1006
US

IV. Provider business mailing address

12127B HWY 14 N STE 5
CEDAR CREST NM
87008-9499
US

V. Phone/Fax

Practice location:
  • Phone: 505-832-4434
  • Fax: 505-832-5024
Mailing address:
  • Phone: 505-281-5180
  • Fax: 505-832-5024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. VICTORIA LYNN GALLEGOS
Title or Position: OFFICE MANAGER
Credential:
Phone: 505-832-4434