Basic Information
| Provider Information | |||||||||
| NPI: | 1619094109 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | GILA REGIONAL MEDICAL CENTER | ||||||||
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| OtherOrganizationName: | PSYCHIATRIC | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1313 E 32ND ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 880617251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055384000 | ||||||||
| FaxNumber: | 5053889847 | ||||||||
| Practice Location | |||||||||
| Address1: | 1313 E 32ND ST | ||||||||
| Address2: | |||||||||
| City: | SILVER CITY | ||||||||
| State: | NM | ||||||||
| PostalCode: | 88061 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5055384000 | ||||||||
| FaxNumber: | 5053889847 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2007 | ||||||||
| LastUpdateDate: | 06/26/2018 | ||||||||
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| AuthorizedOfficialLastName: | STOKES | ||||||||
| AuthorizedOfficialFirstName: | RICHARD | ||||||||
| AuthorizedOfficialMiddleName: | W | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5755384130 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 273R00000X | 6095 | NM | Y | Hospital Units | Psychiatric Unit |
ID Information
| ID | Type | State | Issuer | Description | 554 | 05 | NM | MEDICAID |