Healthcare Provider Details

I. General information

NPI: 1831555366
Provider Name (Legal Business Name): GILA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2016
Last Update Date: 06/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1302 E 32ND ST LAMONTANA PLAZA
SILVER CITY NM
88061
US

IV. Provider business mailing address

1313 E 32ND ST
SILVER CITY NM
88061-7251
US

V. Phone/Fax

Practice location:
  • Phone: 575-534-9578
  • Fax:
Mailing address:
  • Phone: 575-538-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: RICHARD W STOKES
Title or Position: CFO
Credential:
Phone: 575-538-4130