DHHS,PHS,Naihs,Gallup Indian Medical Center
Organization Active NPI Skilled Nursing Facility · Gallup, NM
NPI 1215106935 · NPPES record last updated Feb 12, 2025
Key facts
- NPI
- 1215106935
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Skilled Nursing Facility 314000000X
- License
- 9435
- Legal business name
- DHHS,PHS,NAIHS,GALLUP INDIAN MEDICAL CENTER
- Practice address
- 224 Nizhoni Blvd
Gallup, NM 87301-5744 - Phone
- (505) 722-1000
- Fax
- (505) 722-1310
- NPI assigned
- Feb 27, 2008
- Organization subpart
- No
Authorized official
- Name
- Pamela Detsoi-Smiley, CEO
- Title
- Chief Executive Officer
- Phone
- (505) 722-1000
Other NPIs on the same Medicare enrollment 5
Corporate family (same tax ID) 10
Practitioners 6
-
Kevin Don Gaines, MD
-
Jonathan Vilasier Iralu, M.D.
-
Elizabeth Ann Ketner, M.H.S., MD
-
David Emanuel Green, M.D.
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20031111000840 | TX | Part B Supplier - Clinic/Group Practice | 3173436409 |
Receives reassigned benefits from 617 practitioners 5 other NPIs on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Gallup, NM; Tohatchi, NM |
National Provider Directory
- Tax ID family
- Dhhsphsnaihsgallup Indian Medical Center
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Skilled Nursing Facility | 314000000X | 9435 | Yes |
Addresses
Primary practice location
224 Nizhoni Blvd
Gallup, NM 87301-5744
Mailing address
PO Box 1337
Gallup, NM 87305-1337
Phone (505) 722-1000
Other names
- McKinley Manor
Other providers in Gallup, NM
- 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
- Quint Di Giacomo
- Claudia Yvette Diaz
All providers in Gallup, NM · Skilled Nursing Facility 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.