Healthcare Provider Details

I. General information

NPI: 1568017143
Provider Name (Legal Business Name): GILA REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/09/2019
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 E 32ND ST
SILVER CITY NM
88061-7229
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 575-538-4130
  • Fax:
Mailing address:
  • Phone: 575-538-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: DOROTHY SHULER
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 575-574-4912