Organization
ACOMA CANONCITO LAGUNA INDIAN
Active
Other names
DHHS USPHS INDIAN HEALTH SERVICES
Organization subpart
No
Provider details
NPI number
Authorized official
BARBARA FELIPE (ACL IHS CEO)
(505) 552-5303
Entity
Organization
Contact information
Practice address
EXIT 102 OFF I-40 1/2 MI SOUTH, SAN FIDEL, NM 87049-0130
(505) 552-5385
(505) 552-5490
Mailing address
PO BOX 130, ACOMA CANONCITO LAGUNA INDIAN HOSPITAL, SAN FIDEL, NM 87049-0130
(505) 552-5385
(505) 552-5490
Taxonomy
Speciality
Code
Description
License number
State
341600000X
Ambulance
Primary
14909596
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
14909596
—
NM
01
—
320070
MEDICARE PART A
—
Enumeration date
08/14/2007
Last updated
01/11/2012
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