Organization
PRESBYTERIAN MEDICAL SERVICES
Active
Other names
WESTERN NM MED GROUP GALLOP
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERTA LEE (CFO)
(505) 982-5565
Entity
Organization
Contact information
Practice address
610 N 5TH ST, GALLUP, NM 87301-5306
(505) 863-3120
(505) 863-2961
Mailing address
PO BOX 2267, RMACY, SANTA FE, NM 87504-2267
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
NM
332900000X
Non-Pharmacy Dispensing Site
CL00007461
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3209675
OTHER ID NUMBER
—
05
—
50526
—
NM
Enumeration date
11/29/2006
Last updated
07/21/2022
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