Healthcare Provider Details

I. General information

NPI: 1538542485
Provider Name (Legal Business Name): COUNTY OF MCKINLEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2015
Last Update Date: 07/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#65 1ST STREET
THOREAU NM
87323
US

IV. Provider business mailing address

PO BOX 70
GALLUP NM
87305-0070
US

V. Phone/Fax

Practice location:
  • Phone: 505-862-7482
  • Fax: 505-862-7486
Mailing address:
  • Phone: 505-863-1400
  • Fax: 505-863-6362

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code341600000X
TaxonomyAmbulance
License Number341600000
License Number StateNM

VIII. Authorized Official

Name: WILLIAM E. LEE
Title or Position: COUNTY MANAGER
Credential:
Phone: 505-863-1400