Healthcare Provider Details

I. General information

NPI: 1780001495
Provider Name (Legal Business Name): DAN C. TRIGG MEMORIAL HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2014
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E MIEL DE LUNA AVE
TUCUMCARI NM
88401-3810
US

IV. Provider business mailing address

PO BOX 885
TUCUMCARI NM
88401-0885
US

V. Phone/Fax

Practice location:
  • Phone: 575-461-7230
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number4312
License Number StateNM

VIII. Authorized Official

Name: MRS. MISTY M JOHNSON
Title or Position: PT
Credential:
Phone: 575-461-7230