Organization
CIBOLA GENERAL HOSPITAL CORPORATION
Active
Organization
CIBOLA GENERAL HOSPITAL CORPORATION
Active
Other names
Cibola Family Health Center
Organization subpart
No
Provider details
NPI number
Authorized official
DONNA ROJAS (CREDENTIALING SPECIALIST)
(505) 287-5202
Entity
Organization
Contact information
Practice address
1423 E ROOSEVELT AVE, GRANTS, NM 87020-2245
(505) 287-6500
(505) 287-5393
Mailing address
1423 E ROOSEVELT AVE, GRANTS, NM 87020-2245
(505) 287-6500
(505) 287-5393
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
—
—
208600000X
Surgery Physician
—
—
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
323409
MEDICARE PTAN
NM
05
—
63306514
—
NM
Enumeration date
03/23/2010
Last updated
08/18/2020
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