Organization
CANONCITO COMMUNITY CLINIC
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 #131 OFF I 40 6 MILES NORTH, SAN FIDEL, NM 87049-0130
(505) 552-5385
(505) 552-5828
Mailing address
ACOMA CANONCITO LAGUNA INDIAN HOSPITAL, PO BOX 130, SAN FIDEL, NM 87049
(505) 552-5385
(505) 552-5490
Taxonomy
Speciality
Code
Description
License number
State
282N00000X
General Acute Care Hospital
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
320070
RAILROAD MEDICARE
NM
01
—
HSZ022
RAILROAD MEDICARE
NM
05
—
L9815
—
NM
Enumeration date
11/21/2006
Last updated
01/09/2012
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