Western Nm Med Grp- Bh-gallup | |
2025 E Aztec Ave Gallup NM 87301-4803 | |
(505) 863-3828 | |
(505) 863-6612 |
Full Name | Western Nm Med Grp- Bh-gallup |
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Speciality | Clinic/Center |
Location | 2025 E Aztec Ave, Gallup, New Mexico |
Authorized Official Name and Position | Doug Smith (EXECUTIVE VICE PRESIDENT) |
Authorized Official Contact | 5059825565 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Western Nm Med Grp- Bh-gallup Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | Western Nm Med Grp- Bh-gallup 2025 E Aztec Ave Gallup NM 87301-4803 Ph: (505) 863-3828 |
NPI Number | 1225140783 |
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Provider Enumeration Date | 08/31/2006 |
Last Update Date | 01/09/2021 |
Medicare PECOS PAC ID | 2062324684 |
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Medicare Enrollment ID | O20110712000213 |
Identifier | Type | State | Issuer |
---|---|---|---|
1225140783 | NPI | - | NPPES |
50526 | Medicaid | NM |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 6615 (New Mexico) | Primary |
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