Provider Demographics
NPI:1093814691
Name:COCHITI HEALTH CLINIC
Entity Type:Organization
Organization Name:COCHITI HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACTING CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRET
Authorized Official - Middle Name:A
Authorized Official - Last Name:SMOKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-988-9821
Mailing Address - Street 1:PO BOX 150
Mailing Address - Street 2:
Mailing Address - City:COCHITI PUEBLO
Mailing Address - State:NM
Mailing Address - Zip Code:87072-0150
Mailing Address - Country:US
Mailing Address - Phone:505-465-2587
Mailing Address - Fax:505-465-3018
Practice Address - Street 1:255 COCHITI ST
Practice Address - Street 2:
Practice Address - City:COCHITI PUEBLO
Practice Address - State:NM
Practice Address - Zip Code:87072-9998
Practice Address - Country:US
Practice Address - Phone:505-465-2587
Practice Address - Fax:505-465-3018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-21
Last Update Date:2011-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMH1232282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMH1232Medicaid
NMH1232Medicaid
NMHSZ181Medicare PIN