| Gallup Teen Health Center | |
|
1055 Rico St Gallup NM 87301-8003 | |
| (505) 863-3821 | |
| Not Available |
| Full Name | Gallup Teen Health Center |
|---|---|
| Speciality | Clinic/Center |
| Location | 1055 Rico St, Gallup, New Mexico |
| Authorized Official Name and Position | Doug Smith (EXECUTIVE VICE PRESIDENT) |
| Authorized Official Contact | 5059825565 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gallup Teen Health Center Po Box 2267 Santa Fe NM 87504-2267 Ph: (505) 982-5565 | Gallup Teen Health Center 1055 Rico St Gallup NM 87301-8003 Ph: (505) 863-3821 |
| NPI Number | 1669540076 |
|---|---|
| Provider Enumeration Date | 12/01/2006 |
| Last Update Date | 01/09/2021 |
| Medicare PECOS PAC ID | 2062324684 |
|---|---|
| Medicare Enrollment ID | O20100120000414 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669540076 | NPI | - | NPPES |
| 50526 | Medicaid | NM |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QS1000X | Clinic/center - Student Health | 6437 (New Mexico) | Primary |
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