| Pueblo Pintado Clinic | |
|
#10 Pueblo Pintado School Cuba NM 87013 | |
| (505) 655-3501 | |
| (505) 862-8909 |
| Full Name | Pueblo Pintado Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | #10 Pueblo Pintado School, Cuba, New Mexico |
| Authorized Official Name and Position | Anslem Roanhorse (CEO) |
| Authorized Official Contact | 5057865291 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Pueblo Pintado Clinic Po Box 358 Crownpoint NM 87313-0358 Ph: (505) 655-6501 | Pueblo Pintado Clinic #10 Pueblo Pintado School Cuba NM 87013 Ph: (505) 655-3501 |
| NPI Number | 1023051133 |
|---|---|
| Provider Enumeration Date | 06/14/2006 |
| Last Update Date | 10/18/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1023051133 | NPI | - | NPPES |
| HSZ144 | Other | NM | MEDICARE GROUP PTAN |
| R2915 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Presbyterian Medical Services Primary Care Clinic Medicare: Medicare Enrolled Practice Location: #50 County Road 13, Cuba, NM 87013 Phone: 575-289-2082 Fax: 575-289-2029 | |
Richard Kozoll, Md, Los Pinos Family Health Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 6362 Main Street, Cuba, NM 87013 Phone: 505-289-3326 Fax: 505-289-3390 |