NPIMap

Organization Active NPI

Gallup Indian Medical Center

Doing business as Fort Wingate Dental Clinic

  • Dental Clinic/Center
  • Fort Wingate, NM
National Provider Identifier
1952505208
Registry record updated Jul 22, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
9435
Legal business name
GALLUP INDIAN MEDICAL CENTER
Doing business as
Fort Wingate Dental Clinic
Practice address
520 B Shush Drive
Exit 33 State Road 400
Ft . Wingate, NM 87316
Phone
(505) 722-1770
Fax
(505) 722-1796
NPI assigned
Jun 12, 2007
Last updated
Jul 22, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2008

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

Authorized official

Name
Bennie C. Yazzie
Title
Acting Ceo
Phone
(505) 722-1000

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X 9435 Primary

Addresses

Primary practice location

520 B Shush Drive
Exit 33 State Road 400
Ft . Wingate, NM 87316

Mailing address

516 E. Nizhoni Blvd
Gallup, NM 87301-1337
Phone (505) 722-1770

Other identifiers 1

IdentifierTypeStateIssuer
27603725MedicaidNM

Other names 1

  • Fort Wingate Dental Clinic Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Dhhsphsnaihsgallup Indian Medical Center11 organizations share this tax ID, including this one

Other organizations with this tax ID 10

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": "1181606400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1216684800000",
    "number": "1952505208",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "516 E. NIZHONI BLVD",
            "city": "GALLUP",
            "state": "NM",
            "postal_code": "873011337",
            "telephone_number": "505-722-1770",
            "fax_number": "505-722-1796"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 B SHUSH DRIVE",
            "address_2": "EXIT 33 STATE ROAD 400",
            "city": "FT . WINGATE",
            "state": "NM",
            "postal_code": "87316",
            "telephone_number": "505-722-1770",
            "fax_number": "505-722-1796"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GALLUP INDIAN MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-06-12",
        "last_updated": "2008-07-22",
        "status": "A",
        "authorized_official_last_name": "YAZZIE",
        "authorized_official_first_name": "BENNIE",
        "authorized_official_middle_name": "C.",
        "authorized_official_title_or_position": "ACTING CEO",
        "authorized_official_telephone_number": "505-722-1000"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": null,
            "license": "9435",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "27603725",
            "state": "NM"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fort Wingate Dental Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fort Wingate, NM

Sources for this page

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