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1900 Red Rock Dr Gallup NM 87301-5682 | |
| (505) 863-7200 | |
| (505) 726-6734 |
| Full Name | |
|---|---|
| Speciality | Clinic/Center |
| Location | 1900 Red Rock Dr, Gallup, New Mexico |
| Authorized Official Name and Position | Wayne Gillis (CEO) |
| Authorized Official Contact | 5058637001 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
1901 Redrock Dr Gallup NM 87301-5683 Ph: (505) 863-7000 | 1900 Red Rock Dr Gallup NM 87301-5682 Ph: (505) 863-7200 |
| NPI Number | 1689779860 |
|---|---|
| Provider Enumeration Date | 09/13/2006 |
| Last Update Date | 12/04/2024 |
| Certification Date | 12/04/2024 |
| Medicare PECOS PAC ID | 1759293855 |
|---|---|
| Medicare Enrollment ID | O20190802000233 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1689779860 | NPI | - | NPPES |
| CR0819/CT1912 | Other | RR MC / CLINIC LOCATIONS | |
| 326258 | Medicaid | AZ | |
| E9167 | Medicaid | NM | |
| 202004510 | Other | PH/CLINIC LOCATIONS | |
| 77409019 | Medicaid | NM | |
| NM005081 | Other | NM | ALL CLINIC LOCATIONS |
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