NPIMap

Organization Active NPI

Gallup Community Health

  • Federally Qualified Health Center (FQHC)
  • Gallup, NM
National Provider Identifier
1336807254
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Federally Qualified Health Center (FQHC)Taxonomy code 261QF0400X
Legal business name
GALLUP COMMUNITY HEALTH
Practice address
2111 College Dr
Gallup, NM 87301-5600
Phone
(505) 397-5381
Fax
(877) 396-1184
NPI assigned
Dec 8, 2021
Last updated
Jul 31, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Valory Wangler, MDNPI 1457579963
Title
Ceo
Phone
(206) 861-5767

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 10

Specialty (taxonomy)CodeLicenseStatePrimary
Federally Qualified Health Center (FQHC) 261QF0400X NU Primary
Addiction (Substance Use Disorder) Counselor 101YA0400X NU
Mental Health Counselor 101YM0800X NU
Psychologist 103T00000X NU
Counseling Psychologist 103TC1900X NU
Family Medicine Physician 207Q00000X NU
Community Health Worker 172V00000X NU
Prescribing (Medical) Psychologist 103TP0016X NU
Peer Specialist 175T00000X NU
Behavior Technician 106S00000X NU

Addresses

Primary practice location

2111 College Dr
Gallup, NM 87301-5600

Mailing address

2111 College Dr
Gallup, NM 87301-5600
Phone (505) 397-5381

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NM2 enrollments

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
O20220815001928 NM Part B Supplier - Clinic/Group Practice 3375926975 Receives reassigned benefits from 22 practitioners
Practice locations: Gallup, NM
O20240719002067 NM Part A Provider - Federally Qualified Health Center (FQHC) 3375926975 Practice locations: Gallup, NM

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1336807254. Details of each certification follow.

Federally qualified health center certification: CCN 321003

Legal name
GALLUP COMMUNITY HEALTH
Certification status
Active
Provider type (POS)
Federally qualified health center
Participating since
Jul 17, 2024
Last certification
Jul 17, 2024
Ownership / control type
For profit – corporation
Organization structure
LLCNon-profit
Incorporated
Jul 1, 2022 in NM
Enrollment address
2111 College Dr
Gallup, NM 87301-5600

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
32D2266511Gallup Community Health Clinic2111 College Dr, Gallup, NM 87301Provider-performed microscopySep 30, 2027

National Provider Directory

National Provider Directory

Locations

2111 College Dr
Gallup, NM 87301
Phone (505) 397-5172

Interoperability endpoints

  • FHIR API: https://fhir4.healow.com/fhir/r4/FBBICD

Ownership & related parties

All disclosed owners & managing parties 12

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Hannah C Palm Individual Corporate OfficerVice Chair/Secretary Aug 1, 2022
Brittany Babycos Individual Corporate OfficerBoard Member Mar 1, 2023
Jonah Connor Individual Corporate OfficerBoard Member Apr 1, 2024
Elizabeth Herron Individual Corporate OfficerBoard Member Aug 1, 2022
Janet Zunie Individual Corporate OfficerBoard Member Jul 1, 2023
Zunneh-Bah Jim Individual Corporate OfficerBoard Member Jun 1, 2023
Lindsey Smith-Mingus Individual Corporate OfficerBoard Member Mar 1, 2023
Elaine Villarta Individual Corporate OfficerBoard Member Apr 1, 2023
Vanessa Sandoval Individual Corporate OfficerBoard Member Jul 1, 2023
Christopher Robert Vesely Hoover Individual Corporate OfficerBoard Treasurer Aug 1, 2022
Bruce D Forman Individual Corporate OfficerBoard Chair Aug 1, 2022
Valory E Wangler Individual Corporate Officer Jul 1, 2022
W-2 Managing EmployeeExecutive Director Jul 5, 2022

Owners & managing parties with NPI records 3

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

Practitioners & affiliated clinicians

Practitioners 38

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 38

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1638921600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1336807254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 COLLEGE DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015600",
            "telephone_number": "505-397-5381"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 COLLEGE DR",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873015600",
            "telephone_number": "505-397-5381",
            "fax_number": "877-396-1184"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLUP COMMUNITY HEALTH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-12-08",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "WANGLER",
        "authorized_official_first_name": "VALORY",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "206-861-5767",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QF0400X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Federally Qualified Health Center (FQHC)",
            "state": "NU",
            "license": null,
            "primary": true
        },
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TC1900X",
            "taxonomy_group": "",
            "desc": "Psychologist, Counseling",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "172V00000X",
            "taxonomy_group": "",
            "desc": "Community Health Worker",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TP0016X",
            "taxonomy_group": "",
            "desc": "Psychologist, Prescribing (Medical)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "175T00000X",
            "taxonomy_group": "",
            "desc": "Peer Specialist",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gallup, NM

Sources for this page

Verify at the official NPI Registry.