Organization
GALLUP INDIAN MEDICAL CENTER
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAMELA DETSOI-SMILEY CEO (CHIEF EXECUTIVE OFFICER)
(505) 722-1000
Entity
Organization
Contact information
Practice address
516 NIZHONI BLVD, GALLUP, NM 87301-5748
(505) 722-1000
(505) 722-1310
Mailing address
PO BOX 1337, GALLUP, NM 87305-1337
(505) 722-1000
(505) 722-1310
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
9435
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1507755
UCC GROUP NUMBER
NM
Enumeration date
04/01/2008
Last updated
02/12/2025
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