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Organization
NIZHONI MEDICAL SUPPLY INC
Active
Organization
NIZHONI MEDICAL SUPPLY INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VERNON DAKAI WARNER I (SECRETARY)
(505) 863-9199
Entity
Organization
Contact information
Practice address
1303 METRO AVE, GALLUP, NM 87301-5376
(505) 863-9199
(505) 863-9219
Mailing address
1303 METRO DR, GALLUP, NM 87301-4862
(505) 863-9199
(505) 863-9219
Taxonomy
Speciality
Code
Description
License number
State
332BX2000X
Oxygen Equipment & Supplies (DME)
Primary
—
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
094395
AHCCCS PROVIDER NUMBER
AZ
05
—
35488557
—
NM
01
—
N123894
INTERGRATED HEALTH
NM
Enumeration date
10/02/2006
Last updated
07/29/2009
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