1194797779 NPI number — DARRYL MACIAS MD

Table of content: DARRYL MACIAS MD (NPI 1194797779)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194797779 NPI number — DARRYL MACIAS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MACIAS
Provider First Name:
DARRYL
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1194797779
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Provider Second Line Business Mailing Address:
1901 RED ROCK DRIVE
Provider Business Mailing Address City Name:
GALLUP
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87301
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-863-7000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
REHOBOTH MCKINLEY CHRISTIAN HEALTH CARE SERVICES
Provider Second Line Business Practice Location Address:
1901 RED ROCK DRIVE
Provider Business Practice Location Address City Name:
GALLUP
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
87301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-863-7000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  93-319 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 16592 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: NM007580 . This is a "BCBS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: PROVP14220 . This is a "MOLINA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 176207 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201006171 . This is a "PRESBYTERIAN HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: P00200863 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 10001036 . This is a "LOVELACE HEALTH/SALUD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com