Cibola Specialty Associates
Organization Active NPI Multi-Specialty Clinic/Center · Grants, NM
NPI 1003444647 · NPPES record last updated Jan 11, 2021
Key facts
- NPI
- 1003444647
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Multi-Specialty Clinic/Center 261QM1300X
- Legal business name
- CIBOLA SPECIALTY ASSOCIATES
- Practice address
- 1208 Bonita St
Grants, NM 87020-2234 - Phone
- (505) 287-4446
- NPI assigned
- Mar 30, 2020
- Organization subpart
- No
Authorized official
- Name
- Thomas Whelan
- Title
- Ceo
- Phone
- (505) 287-5300
Corporate family (same tax ID) 2
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 32D2275721 | Cibola Specialty Associates | Certificate of waiver | Jan 25, 2027 |
National Provider Directory
- Tax ID family
- Cibola Family Health Center
Locations
1016 E Roosevelt Ave
Grants, NM 87020
Phone (505) 287-4446
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Cardiovascular Disease Physician |
207RC0000X | |||
| Orthopaedic Surgery Physician |
207X00000X | |||
| Surgery Physician |
208600000X | |||
| Multi-Specialty Clinic/Center | 261QM1300X | Yes |
Addresses
Primary practice location
1208 Bonita St
Grants, NM 87020-2234
Mailing address
1016 E Roosevelt Ave
Grants, NM 87020-2118
Phone (505) 287-4446
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 46102 | Medicaid | NM |
Other providers in Grants, NM
- Christy E Cheromiah
- Ann K Church
- Cibola General Hospital Corporation
- Cibola General Hospital Corporation
- Cibola General Hospital Phcy
- Cibola Sports and Physical Therapy
- Elven Ray Clemons
- Jolene Colburn
- County of Cibola
- John David Coyle
All providers in Grants, NM · Multi-Specialty Clinic/Center in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jan 11, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.