NPIMap

Organization Active NPI

Thoreau Health Station

  • Clinic Pharmacy
  • Crownpoint, NM
National Provider Identifier
1508080987
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic PharmacyTaxonomy code 3336C0002X
License
AU4720846 Issued in NM
Legal business name
THOREAU HEALTH STATION
Practice address
Hwy 371 Route 9
Crownpoint, NM 87313-0358
Phone
(505) 786-6344
Fax
(505) 786-6440
NPI assigned
Apr 13, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Stacy Williams
Title
Chief Pharmacist
Phone
(505) 786-6344

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic Pharmacy 3336C0002X AU4720846 NM Primary

Addresses

Primary practice location

Hwy 371 Route 9
Crownpoint, NM 87313-0358

Mailing address

PO Box 358
Crownpoint, NM 87313-0358
Phone (505) 786-6344

Other identifiers 2

IdentifierTypeStateIssuer
47209MedicaidNM
021189MedicaidAZ

National Provider Directory

National Provider Directory
Tax ID family
Thoreau Clinic7 organizations share this tax ID, including this one

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1508080987",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 358",
            "city": "CROWNPOINT",
            "state": "NM",
            "postal_code": "873130358",
            "telephone_number": "505-786-6344",
            "fax_number": "505-786-6440"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "HWY 371 ROUTE 9",
            "city": "CROWNPOINT",
            "state": "NM",
            "postal_code": "873130358",
            "telephone_number": "505-786-6344",
            "fax_number": "505-786-6440"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THOREAU HEALTH STATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-13",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WILLIAMS",
        "authorized_official_first_name": "STACY",
        "authorized_official_title_or_position": "CHIEF PHARMACIST",
        "authorized_official_telephone_number": "505-786-6344"
    },
    "taxonomies": [
        {
            "code": "3336C0002X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Clinic Pharmacy",
            "state": "NM",
            "license": "AU4720846",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "47209",
            "state": "NM"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "021189",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Crownpoint, NM

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.