Healthcare Provider Details

I. General information

NPI: 1073671194
Provider Name (Legal Business Name): PINE HILL HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 01/10/2023
Certification Date: 01/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BIA RT 125
PINE HILL NM
87357
US

IV. Provider business mailing address

PHARMACY DEPT PO BOX 310
PINE HILL NM
87357
US

V. Phone/Fax

Practice location:
  • Phone: 505-775-3271
  • Fax: 505-775-3633
Mailing address:
  • Phone: 505-775-3271
  • Fax: 505-775-3633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332800000X
TaxonomyIndian Health Service/Tribal/Urban Indian Health (I/T/U) Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: WILLIAM BECKER
Title or Position: CLINIC ADMINISTRATOR
Credential:
Phone: 505-775-3271