1336220839 NPI number — GILA REGIONAL MEDICAL CENTER

Table of content: (NPI 1336220839)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336220839 NPI number — GILA REGIONAL MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GILA REGIONAL MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1336220839
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/07/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1313 E 32ND ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER CITY
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88061-7251
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-538-4000
Provider Business Mailing Address Fax Number:
505-538-2824

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3202 N. RIDGE LOOP
Provider Second Line Business Practice Location Address:
SILVER CITY,
Provider Business Practice Location Address City Name:
SILVER CITY
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88061-8806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-388-9708
Provider Business Practice Location Address Fax Number:
575-342-2953
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WHITAKER
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
575-538-4000

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 6095 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 6095 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HS173IP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0719773 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200267710A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: GIL0016N , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 026585 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135218100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS173OP , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00NM00057 . This is a "BCBS NEW MEXICO" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 574159201A , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9017615-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00570 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149132105 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200495290A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27884384 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP30517 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1761869 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: XHSP40517 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01500180 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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