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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