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General NPI Number Information
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NPI Number | 1326217043
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Entity Type | Organization
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Legal Business Name | DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 02/12/2025
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Provider Practice Location Address
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Address Line | 1900 MARK AVE
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City | GALLUP
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State | NM
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Zip | 87301-4822
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Country | US
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Telephone | 505-722-1000
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Fax | 505-722-1310
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Provider Business Mailing Address
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Address Line | PO BOX 1337
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City | GALLUP
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State | NM
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Zip | 87305-1337
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Country | US
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Telephone | 505-722-1000
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Fax | 505-722-1310
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | PAMELA DETSOI-SMILEY
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Credential | CEO
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Telephone | 505-722-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number | 9435
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License Number State |
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