Healthcare Provider Details

I. General information

NPI: 1730722265
Provider Name (Legal Business Name): GILA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3185 N LESLIE RD
SILVER CITY NM
88061-7211
US

IV. Provider business mailing address

3185 N LESLIE RD
SILVER CITY NM
88061-7211
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-0400
  • Fax: 575-534-0600
Mailing address:
  • Phone: 575-534-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W STOKES
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 575-538-4130