New Mexico Mountain Healthcare

Primary specialty

Rural Health Clinic/CenterTaxonomy code 261QR1300X

License

97-229 Issued in NM

Legal business name

NEW MEXICO MOUNTAIN HEALTHCARE

Practice address

348 St. Rd. 4
San Ysidro, NM 87053

Phone

(505) 404-6048

NPI assigned

Jul 29, 2008

Last updated

Jul 30, 2008By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mark G Dumal, PHD

Title

Ceo

Phone

(505) 404-6048

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1217289600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1217376000000",
    "number": "1508021627",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "348 ST. RD. 4",
            "city": "SAN YSIDRO",
            "state": "NM",
            "postal_code": "87053",
            "telephone_number": "505-404-6048"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "348 ST. RD. 4",
            "city": "SAN YSIDRO",
            "state": "NM",
            "postal_code": "87053",
            "telephone_number": "505-404-6048"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NEW MEXICO MOUNTAIN HEALTHCARE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-07-29",
        "last_updated": "2008-07-30",
        "status": "A",
        "authorized_official_last_name": "DUMAL",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "505-404-6048",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": "NM",
            "license": "97-229",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paula S Practice (San Ysidro Health Clinic)
• Zia Indian Health Clinic Pharmacy

• Rural Health Clinic/Center in San Ysidro, NM
• Providers in San Ysidro, NM by specialty
• Rural Health Clinic/Center in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.