Pueblo Pintado Clinic | |
#10 Pueblo Pintado School Cuba NM 87013 | |
(505) 655-3501 | |
(505) 862-8909 |
Full Name | Pueblo Pintado Clinic |
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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 |
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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 |
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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 |