Organization
CIBOLA SPECIALTY ASSOCIATES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
THOMAS WHELAN (CEO)
(505) 287-5300
Entity
Organization
Contact information
Practice address
1208 BONITA ST, GRANTS, NM 87020-2234
(505) 287-4446
Mailing address
1016 E ROOSEVELT AVE, GRANTS, NM 87020-2118
(505) 287-4446
(505) 287-5213
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
—
—
207X00000X
Orthopaedic Surgery Physician
—
—
208600000X
Surgery Physician
—
—
261QM1300X
Multi-Specialty Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
46102
—
NM
Enumeration date
03/30/2020
Last updated
01/11/2021
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