DHHS, PHS, Naihs, Gallup Indian Medical Center
Organization Active NPI Ambulatory Surgical Clinic/Center · Gallup, NM
NPI 1184890899 · NPPES record last updated Feb 12, 2025
Key facts
- NPI
- 1184890899
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Ambulatory Surgical Clinic/Center 261QA1903X
- License
- 9335
- Legal business name
- DHHS, PHS, NAIHS, GALLUP INDIAN MEDICAL CENTER
- Practice address
- 516 Nizhoni Blvd
Gallup, NM 87301-5748 - Phone
- (505) 722-1000
- Fax
- (505) 722-1310
- NPI assigned
- May 2, 2008
- Organization subpart
- No
Authorized official
- Name
- Pamela Detsoi-Smiley, CEO
- Title
- Ceo
- Phone
- (505) 722-1000
Other NPIs with the same Medicare PAC ID 1
Practitioners 187
-
Lynn Ann Abeita, PHD
-
Margot Albert, MD
-
Kandace Alfred, OD
-
Neil Pitero Barranta, CRNA
-
Jennifer Michelle Bass, M.D.
-
George Brasinikas, M.D.
-
Maria Ynes Brueckner, M.D.
-
Paul William Charlton, M.D.
-
Duane Chase, MD
-
Kristine Cruz, M.D.
-
Judith S. Denina, MD
-
Angela R Dorsey, D.O.
-
Mufaro Dube, MD
-
Ayodele Olumide Erinle, M.D.
-
Kandyse Flanigan, OD
-
Jack B Fralinger, M.D.
-
Stephen M Friedman, M.D.
-
Kevin Don Gaines, MD
-
Roen Garcia, M.D.
-
Devin Glasses, PA-C
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20071220000593 | TX | Part B Supplier - Ambulatory Surgical Center | 3173436409 | Practice locations: Gallup, NM |
National Provider Directory
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ambulatory Surgical Clinic/Center | 261QA1903X | 9335 | Yes |
Addresses
Primary practice location
516 Nizhoni Blvd
Gallup, NM 87301-5748
Mailing address
PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174371 | Medicaid | NM |
Other providers in Gallup, NM
- Daisy Descheene
- Desert Horizon Transport LLC
- Fern S. Detsoi
- Brande-Jo Deutsawe
- Desiderio Jay Dez
- DHHS,PHS,Naihs, Gallup Indian Medical Center
- DHHS,PHS,Naihs,Gallup Indian Medical Center
- DHHS,PHS,Naihs,Gallup Indian Medical Center
- DHHS,PHS,Naihs,Gallup Indian Medical Center
- DHHS,PHS,Naihs,Gallup Indian Medical Center
All providers in Gallup, NM · Ambulatory Surgical 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 Feb 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.