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General NPI Number Information
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NPI Number | 1285811208
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Entity Type | Organization
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Legal Business Name | GALLUP INDIAN MEDICAL CENTER
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Dates
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Enumeration Date | 01/22/2008
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Last Update Date | 09/12/2008
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Provider Practice Location Address
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Address Line | 516 NIZHONI BLVD
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City | GALLUP
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State | NM
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Zip | 87301-5748
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Country | US
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Telephone | 505-722-1315
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Fax |
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Provider Business Mailing Address
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Address Line | 519 NIZHONI BOULAVARD
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City | GALLUP
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State | NM
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Zip | 87301
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Country | US
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Telephone | 505-722-1315
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Fax |
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Authorized Official
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Title or Position | REGISTERED NURSE
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Name | WINIFRED MORRIS-YAZZIE
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Credential | R.N.
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Telephone | 505-722-1315
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 275N00000X
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Taxonomy Name | Medicare Defined Swing Bed Hospital Unit
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License Number | R60069
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License Number State | NM
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